Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan.
Division of Infectious Disease and Tropical Medicine, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan.
Medicina (Kaunas). 2022 Jan 11;58(1):110. doi: 10.3390/medicina58010110.
Antiretroviral therapy (ART) can restore protective immune responses against opportunistic infections (OIs) and reduce mortality in patients with human immunodeficiency virus (HIV) infections. Some patients treated with ART may develop immune reconstitution inflammatory syndrome (IRIS). complex (MAC)-related IRIS most commonly presents as lymphadenitis, soft-tissue abscesses, and deteriorating lung infiltrates. However, neurological presentations of IRIS induced by MAC have been rarely described. We report the case of a 31-year-old man with an HIV infection. He developed productive cough and chronic inflammatory demyelinating polyneuropathy (CIDP) three months after the initiation of ART. He experienced an excellent virological and immunological response. Sputum culture grew MAC. The patient was diagnosed with MAC-related IRIS presenting as CIDP, based on his history and laboratory, radiologic, and electrophysiological findings. : Neurological symptoms improved after plasmapheresis and intravenous immunoglobulin (IVIG) treatment. To our knowledge, this is the first reported case of CIDP due to MAC-related IRIS. Clinicians should consider MAC-related IRIS in the differential diagnosis of CIDP in patients with HIV infections following the initiation of ART.
抗逆转录病毒疗法(ART)可以恢复针对机会性感染(OIs)的保护性免疫反应,并降低人类免疫缺陷病毒(HIV)感染患者的死亡率。一些接受 ART 治疗的患者可能会出现免疫重建炎症综合征(IRIS)。MAC 相关的 IRIS 最常见的表现为淋巴结炎、软组织脓肿和肺浸润恶化。然而,MAC 引起的 IRIS 的神经表现很少有描述。我们报告了一例 31 岁的 HIV 感染男性患者。他在开始 ART 后三个月出现有痰咳嗽和慢性炎症性脱髓鞘性多发性神经病(CIDP)。他经历了极好的病毒学和免疫学反应。痰培养生长 MAC。根据患者的病史和实验室、影像学和电生理学检查结果,该患者被诊断为 MAC 相关 IRIS 表现为 CIDP。:在接受血浆置换和静脉注射免疫球蛋白(IVIG)治疗后,神经症状得到改善。据我们所知,这是首例因 MAC 相关 IRIS 引起的 CIDP 病例。临床医生应在 HIV 感染患者开始 ART 后出现 CIDP 时,考虑 MAC 相关 IRIS 的鉴别诊断。