Cheng Chiu-Hsuan, Hsu Yung-Hsiang
Department of Pathology, Buddhist Tzu Chi General Hospital and University, Taiwan.
School of Medicine, Tzu Chi University, Hualien, Taiwan.
Tzu Chi Med J. 2017 Jan-Mar;29(1):41-45. doi: 10.4103/tcmj.tcmj_9_17.
Immune reconstitution inflammatory syndrome is a collection of inflammatory disorders associated with paradoxical worsening of preexisting infectious processes following the initiation of highly active antiretroviral therapy (HAART) in individuals infected with human immunodeficiency virus (HIV). It involves a wide range of pathogens, neoplasms such as Kaposi's sarcoma (KS) and some autoimmune diseases. We describe an autopsy report of a 40-year-old man infected with HIV. He experienced a rapid dissemination of KS resulting in death within 6 months after starting HAART. His serum viral load had significantly decreased 4 log10 within 32 days and his CD4+ T-cell count increased 4-fold. He presented with multiple skin lesions over the chin and anterior neck, which rapidly spread over the trunk, 4 extremities, perianal region, and penis. Finally, he developed acute dyspnea and a plain chest radiograph showed bilateral pulmonary infiltrations. Despite treatment, he died of acute respiratory failure. At autopsy, multiple KS lesions were noted in the bilateral lungs, liver, kidneys, and gastrointestinal tract. Increased inflammatory cytokines during immune reconstruction from HAART-reactive human herpes virus type-8 infection, linked to the tumorigenesis of KS, finally led to rapid dissemination and death.
免疫重建炎症综合征是一组炎症性疾病，与人类免疫缺陷病毒（HIV）感染者开始高效抗逆转录病毒治疗（HAART）后既往感染过程的反常恶化相关。它涉及多种病原体、卡波西肉瘤（KS）等肿瘤以及一些自身免疫性疾病。我们描述了一名40岁HIV感染男性的尸检报告。他在开始HAART后6个月内经历了KS的快速播散并导致死亡。他的血清病毒载量在32天内显著下降了4个对数10，且CD4+T细胞计数增加了4倍。他的下巴和颈部前方出现多处皮肤病变，并迅速蔓延至躯干、四肢、肛周区域和阴茎。最后，他出现急性呼吸困难，胸部X线平片显示双侧肺部浸润。尽管接受了治疗，他仍死于急性呼吸衰竭。尸检时，在双侧肺、肝、肾和胃肠道发现多处KS病变。HAART反应性人类疱疹病毒8型感染免疫重建过程中炎症细胞因子增加，与KS的肿瘤发生有关，最终导致快速播散和死亡。
