Chabria Shiven, Barakat Lydia, Ogbuagu Onyema
Department of Medicine, Waterbury Hospital, Waterbury, CT, USA.
Yale AIDS Program, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA.
Int J STD AIDS. 2016 Oct;27(11):1026-9. doi: 10.1177/0956462415627735. Epub 2016 Jan 13.
A 51-year-old man with head and neck skin lesions was diagnosed with Kaposi's sarcoma (KS) as his initial presentation of acquired immunodeficiency syndrome. Following initiation of antiretroviral therapy and subsequent full virologic suppression, his facial lesions worsened, consistent with immune reconstitution inflammatory syndrome (IRIS). He was started on glucocorticoids in an attempt to ameliorate the KS-IRIS but experienced paradoxical worsening of the KS lesions. Steroids were subsequently discontinued and he required chemotherapy for severe and cosmetically disfiguring skin lesions. This article describes the potential for worsening of KS lesions in individuals started on glucocorticoids for KS-IRIS as this has been reported rarely in published literature. The mechanisms underlying this phenomenon remain poorly understood but potential explanations are offered in the case discussion. This article aims to raise clinician awareness on the harms of steroid use in patients with KS-IRIS.
一名51岁的男性，最初因头颈部皮肤病变被诊断为卡波西肉瘤（KS），这也是他获得性免疫缺陷综合征的首发表现。在开始抗逆转录病毒治疗并随后实现完全病毒学抑制后，他面部的病变却恶化了，这与免疫重建炎症综合征（IRIS）相符。为了改善KS-IRIS，他开始使用糖皮质激素，但KS病变却出现了矛盾性恶化。随后停用了类固醇，由于严重且毁容性的皮肤病变，他需要进行化疗。本文描述了因KS-IRIS而开始使用糖皮质激素的个体中KS病变恶化的可能性，因为在已发表的文献中对此报道很少。这种现象背后的机制仍知之甚少，但在病例讨论中提供了一些可能的解释。本文旨在提高临床医生对KS-IRIS患者使用类固醇危害的认识。
