Mu Anandit, Shein Thwe Thwe, Jayachandran Priya, Paul Simon
1 Division of Infectious Diseases, University of California San Francisco, Fresno Medical Education Program, Fresno, CA, USA.
2 Department of Medicine, University of California San Francisco, Fresno Medical Education Program, Fresno, CA, USA.
J Int Assoc Provid AIDS Care. 2017 Nov/Dec;16(6):540-545. doi: 10.1177/2325957417729751. Epub 2017 Sep 14.
Coccidioidomycosis causes substantial morbidity and mortality in endemic areas, and dissemination is frequent in patients with impaired cellular immunity such as AIDS. Immune reconstitution inflammatory syndrome (IRIS) is paradoxical clinical worsening after initiation of antiretroviral therapy (ART) in a patient with HIV and a simultaneous opportunistic infection (OI). Immune reconstitution inflammatory syndrome has been well described for a host of mycobacterial, viral, and fungal OIs and malignancies such as Kaposi sarcoma. To date, only 3 cases of IRIS due to coccidioidomycosis have been reported in the literature. At our institution, we report 4 cases of IRIS in HIV-infected patients with disseminated coccidioidomycosis. Unfortunately, all 4 patients died of worsening coccidioidal infection after initiating ART. The optimal timing of ART in patients with AIDS and coccidioidomycosis remains to be elucidated.
球孢子菌病在流行地区可导致严重的发病和死亡，在细胞免疫受损的患者（如艾滋病患者）中播散很常见。免疫重建炎症综合征（IRIS）是指HIV患者在开始抗逆转录病毒治疗（ART）并同时合并机会性感染（OI）后出现的矛盾性临床恶化。免疫重建炎症综合征在许多分枝杆菌、病毒和真菌性OI以及卡波西肉瘤等恶性肿瘤中已有详细描述。迄今为止，文献中仅报道了3例由球孢子菌病引起的IRIS。在我们机构，我们报告了4例HIV感染且播散性球孢子菌病患者发生IRIS的病例。不幸的是，所有4例患者在开始ART后均死于球孢子菌感染恶化。艾滋病合并球孢子菌病患者ART的最佳时机仍有待阐明。
