Sethupathi Meenakshi, Yoganathan Kathir
Department of GUM/HIV, Betsi Cadwaladr University Health Board, Bangor, UK.
Department of Genito-Urinary and HIV Medicine, Abertawe Bro Morgannwg University Health Board, Singleton Hospital, Swansea, South Wales, UK.
BMJ Case Rep. 2015 Jan 6;2015:bcr2014206601. doi: 10.1136/bcr-2014-206601.
A 32-year-old woman was diagnosed HIV positive with disseminated cryptococcal infection in May 2006. Her initial CD4 was 7 cells/µL and she had a right supraclavicular nodal mass, which was biopsied and shown to be consistent with cryptococcal lymphadenitis. She was treated for disseminated cryptococcal infection and was started on antiretroviral medications subsequently. Two years later, she developed a left supraclavicular mass. Her CD4 count was 320 cells/µL and HIV RNA level was undetectable. Investigations and biopsy results were consistent with a late presentation of cryptococcal immune reconstitution inflammatory syndrome (IRIS). She was treated with oral corticosteroids and her symptoms resolved completely. IRIS is a recognised complication of HIV treatment and occurs in a significant percentage of patients within the first 3 months of starting antiretroviral therapy. This case report illustrates the importance of recognising late presentations of IRIS. It is vital to differentiate true cryptococcal lymphadenitis from IRIS-induced cryptococcal lymphadenitis.
一名32岁女性于2006年5月被诊断为HIV阳性，合并播散性隐球菌感染。她最初的CD4细胞计数为7个/微升，右锁骨上有一个淋巴结肿块，经活检显示符合隐球菌性淋巴结炎。她接受了播散性隐球菌感染的治疗，随后开始服用抗逆转录病毒药物。两年后，她出现了左锁骨上肿块。她的CD4细胞计数为320个/微升，HIV RNA水平检测不到。检查和活检结果符合隐球菌免疫重建炎症综合征（IRIS）的晚期表现。她接受了口服皮质类固醇治疗，症状完全缓解。IRIS是HIV治疗中一种公认的并发症，在开始抗逆转录病毒治疗的头3个月内，相当一部分患者会出现这种情况。本病例报告说明了认识IRIS晚期表现的重要性。区分真正的隐球菌性淋巴结炎和IRIS引起的隐球菌性淋巴结炎至关重要。
