Kojima Shu, Asano Takeharu, Ishii Takehiro, Fukuchi Takahiko, Mashima Hirosato
Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Saitama, JPN.
Department of General Medicine, Saitama Medical Center, Jichi Medical University, Saitama, JPN.
Cureus. 2022 Sep 21;14(9):e29428. doi: 10.7759/cureus.29428. eCollection 2022 Sep.
Immunoreconstitution inflammatory syndrome (IRIS) was reported to occur in 7-13% of AIDS patients on anti-retroviral therapy (ART). IRIS due to Mycobacterium infection is one of the most difficult IRIS types to manage. A male patient in his early 70s was diagnosed with AIDS and treated with an ART. One year after starting ART, abdominal ultrasound was performed for screening and a 4 cm hypoechoic mass was found from the outside of the stomach to the surface of the hepatic lateral segment. Based on various imaging tests, including contrast CT, a malignant tumor, such as malignant lymphoma, was suspected. Then, a percutaneous tumor biopsy was performed. Pathologically, the tumor was recognized as mycobacterial granulomas. Disseminated mycobacterium avium complex can produce granulomas anywhere in the body. The patient was diagnosed with a mycobacterial infection associated with IRIS. When an intra-abdominal mass is found in a patient with HIV, both malignancy and mass formation due to opportunistic infections should be considered differential diseases.
据报道，免疫重建炎症综合征（IRIS）发生在接受抗逆转录病毒治疗（ART）的艾滋病患者中的比例为7%至13%。由分枝杆菌感染引起的IRIS是最难处理的IRIS类型之一。一名70岁出头的男性患者被诊断为艾滋病并接受ART治疗。开始ART治疗一年后，进行腹部超声筛查，发现从胃外部到肝外侧段表面有一个4厘米的低回声肿块。基于包括增强CT在内的各种影像学检查，怀疑是恶性肿瘤，如恶性淋巴瘤。随后进行了经皮肿瘤活检。病理检查显示，肿瘤被确认为分枝杆菌肉芽肿。播散性鸟分枝杆菌复合体可在身体任何部位产生肉芽肿。该患者被诊断为与IRIS相关的分枝杆菌感染。当在HIV患者中发现腹腔内肿块时，应将恶性肿瘤和机会性感染引起的肿块形成都视为鉴别诊断疾病。
