Kapoor Vikas, Latif Azka, Warraich Faiza Hassan, Majeed Aneela
Department of Hematology and Oncology, University of Arizona Arizona Health Sciences Center, Tucson, Arizona, USA.
Department of Infectious Diseases, University of Arizona Arizona Health Sciences Center, Tucson, Arizona, USA.
BMJ Case Rep. 2018 Feb 23;2018:bcr-2017-222149. doi: 10.1136/bcr-2017-222149.
Restoration of immune response by highly active antiretroviral therapy (HAART) effectively improved the overall prognosis of HIV infection. However, 25%-31.7% of patients experience paradoxical worsening of pre-existing infections or unmasking of subclinical infections after starting HAART therapy, which is termed as immune reconstitution inflammatory syndrome (IRIS). Acute granulomatous interstitial nephritis as a consequence of IRIS has never been reported with coinfection. Here, we describe an HIV/AIDS patient coinfected with disseminated infection, who presented with acute kidney injury 4.5 months after initiation of HAART. The diagnostic workup revealed IRIS was the cause of acute kidney injury. Short-term course of prednisone (1 mg/kg/day) along with antimycobacterial and HAART regimen achieved significant improvement.
高效抗逆转录病毒疗法（HAART）恢复免疫反应有效改善了HIV感染的总体预后。然而，25% - 31.7%的患者在开始HAART治疗后出现先前存在的感染矛盾性恶化或亚临床感染暴露，这被称为免疫重建炎症综合征（IRIS）。作为IRIS后果的急性肉芽肿性间质性肾炎在合并感染中从未有过报道。在此，我们描述了一名合并播散性感染的HIV/AIDS患者，在开始HAART治疗4.5个月后出现急性肾损伤。诊断检查显示IRIS是急性肾损伤的病因。短期使用泼尼松（1mg/kg/天）联合抗分枝杆菌和HAART方案取得了显著改善。
