Infectious and Tropical Diseases Unit- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro", University of Palermo, Palermo, Italy.
Infectious and Tropical Disease Unit, AOU Policlinico "P. Giaccone", Via del Vespro 129, 90127, Palermo, Italy.
AIDS Res Ther. 2023 May 11;20(1):28. doi: 10.1186/s12981-023-00522-2.
Immune reconstitution inflammatory syndrome (IRIS) associated with syphilis has rarely been described in HIV-infected patients. Diagnosis can be challenging because it is not always possible to discern it from a recent infection or a worsening of an undiagnosed one.
An HIV-positive 42-year-old man with a poor compliance history of antiretroviral therapy presented at our unit and complained of ocular symptoms. Ocular syphilis diagnosis was posed after initial misdiagnosing with cytomegalovirus infection, and antiretroviral therapy compliance improved after switching to a bictegravir-based regimen. Despite intravenous (IV) penicillin, we observed an initial worsening with the appearance of new skin lesions, and IRIS syphilis was suspected. In the literature, 14 cases of IRIS syphilis are described, all regarding male patients. Seven were HIV naïve to therapy, and 7 HIV-experienced with poor therapy compliance. Basal syphilis serology was negative in ten, with subsequent seroconversion after the development of IRIS. IRIS-syphilis development was observed after a median time of 28 days from ART initiation; 10 cases were considered "unmasking-IRIS" and 4 "paradoxical-IRIS". Skin and ocular involvement were the most often reported. In most cases, it was not necessary to use a systemic steroid. A good outcome was reported in 12.
Syphilis should be considered in differential diagnosis with other diseases associated with IRIS. A negative syphilis serology before beginning antiretroviral therapy could convey the impression that syphilis has been ruled out. Whereas a high index of suspicion should be maintained when symptoms suggestive of syphilis, such as ocular and skin manifestations, are noticed after therapy has begun.
免疫重建炎症综合征（IRIS）与梅毒相关，在感染 HIV 的患者中很少见。由于无法总是将其与近期感染或未确诊感染的恶化区分开来，因此诊断具有挑战性。
一名 42 岁的 HIV 阳性男性，抗逆转录病毒治疗的依从性差，到我们科室就诊并主诉眼部症状。在最初误诊为巨细胞病毒感染后，诊断出眼部梅毒，并且在改用基于比替拉韦的方案后，抗逆转录病毒治疗的依从性得到了改善。尽管使用了静脉注射（IV）青霉素，但我们观察到最初病情恶化，出现新的皮肤损伤，怀疑为梅毒 IRIS。在文献中，描述了 14 例梅毒 IRIS 病例，均涉及男性患者。7 例为初次接受治疗的 HIV 感染者，7 例为 HIV 感染者，治疗依从性差。10 例患者的基础梅毒血清学检测结果为阴性，随后在发生 IRIS 后出现血清转化。在开始 ART 后，中位数时间为 28 天观察到 IRIS 梅毒的发展；10 例被认为是“揭盖性 IRIS”，4 例是“矛盾性 IRIS”。皮肤和眼部受累是最常报道的。在大多数情况下，无需使用全身性类固醇。12 例报告了良好的结局。
在与其他与 IRIS 相关的疾病进行鉴别诊断时，应考虑梅毒。在开始抗逆转录病毒治疗之前，梅毒血清学检测结果为阴性可能会给人留下梅毒已排除的印象。但是，当开始治疗后出现眼部和皮肤等提示梅毒的症状时，应保持高度怀疑。
