Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy.
Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 2, 27100, Pavia, Italy.
AIDS Res Ther. 2023 Jul 19;20(1):50. doi: 10.1186/s12981-023-00545-9.
Human immunodeficiency virus (HIV) has a protean clinical picture, in rare instances manifesting as systemic autoimmune disorders such as vasculitides. HIV-induced autoimmune diseases often do not respond well to systemic immunosuppressive therapy. Opportunistic infections may occur in patients with either acquired immunodeficiency syndrome (AIDS) or heavy immunosuppressive treatment, and can further complicate the clinical presentation.
A patient presenting with immunoglobulin A (IgA) vasculitis (IgAV) with treatment-refractory purpuric skin rash and suspect intestinal vasculitis was discovered to have AIDS. HIV was the trigger of IgAV, and cytomegalovirus (CMV) colitis mimicked intestinal vasculitis. Antiretroviral treatment improved both CMV colitis and the control of the autoimmune disease.
An autoimmune disease relapsing despite adequate immunosuppressive treatment and/or the presence of recurrent severe opportunistic infections may be clues to an underlying HIV infection.
人类免疫缺陷病毒（HIV）临床表现多样，罕见情况下可表现为系统性自身免疫性疾病，如血管炎。HIV 引起的自身免疫性疾病通常对系统性免疫抑制治疗反应不佳。机会性感染可发生于获得性免疫缺陷综合征（AIDS）或重度免疫抑制治疗的患者，可进一步使临床表现复杂化。
一名表现为免疫球蛋白 A（IgA）血管炎（IgAV）的患者，其治疗抵抗性紫癜性皮疹和疑似肠道血管炎，被发现患有 AIDS。HIV 是 IgAV 的诱因，巨细胞病毒（CMV）结肠炎模拟肠道血管炎。抗逆转录病毒治疗改善了 CMV 结肠炎和自身免疫性疾病的控制。
尽管进行了充分的免疫抑制治疗和/或反复发生严重机会性感染，但自身免疫性疾病仍复发，这可能提示存在潜在的 HIV 感染。
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