晚期人类免疫缺陷病毒（HIV）不影响利用淋巴结病评估HIV合并结核病患者的药物反应伴嗜酸性粒细胞增多和全身症状综合征：前瞻性对照研究。
Advanced human immunodeficiency virus (HIV) does not affect ability to utilize lymphadenopathy in assessment of drug reaction with eosinophilia and systemic symptoms syndrome in HIV and tuberculosis: Prospective comparative study.
作者信息
Machona Musonda Sharon, Muloiwa Rudzani, Porter Mireille, Peter Jonny, Lehloenya Rannakoe J
机构信息
Department of Medicine, Division of Dermatology, Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa.
Department of Paediatrics, Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa.
出版信息
J Allergy Clin Immunol Glob. 2024 May 3;3(3):100276. doi: 10.1016/j.jacig.2024.100276. eCollection 2024 Aug.
BACKGROUND
RegiSCAR validation criteria for drug reaction with eosinophilia and systemic symptoms (DRESS) includes lymphadenopathy, a frequent feature of both tuberculosis (TB) and human immunodeficiency virus (HIV). TB is the most common HIV-associated coinfection. Advanced HIV is associated with lymph node (LN) fibrosis. It is not clear if this negatively affects case validation in HIV-associated DRESS. To answer this question, we designed a prospective descriptive study to assess lymphadenopathy in various combinations of comorbid HIV, TB, and DRESS.
OBJECTIVES
We sought to describe the prevalence of DRESS-associated lymphadenopathy and characterize LN quality, size, and distribution in a high HIV-TB burden setting over time.
METHODS
We prospectively and systematically examined LN in 25 consecutive acute DRESS cases hospitalized at a South African tertiary-care center and 10 hospitalized non-DRESS HIV-TB coinfected controls.
RESULTS
Fourteen (56%) of 25 patients were HIV infected, with a median (interquartile range) CD4 count of 254 (66-478) cells/mm³, and 7 of 14 were coinfected with TB. Using RegiSCAR criteria, 12 (46%) of 25 were definite DRESS cases, 8 (31%) of 25 probable, and 5 (23%) of 25 possible. Possible cases were excluded in the analysis. Fifteen (75%) of 20 subjects had LN in ≥2 anatomic sites, including all 7 patients with HIV-TB coinfection. In contrast, 1 (20%) of 5 hospitalized non-DRESS HIV-TB coinfected controls had LN. Cervical LN, in 15 (88%) of 17, was most common, followed by axillary (76%) and inguinal (59%). Cervical LN ranged between 1 and 2 cm in size. Among the 8 (32%) of 25 subjects with follow-up data, LN had regressed in all within 6 weeks of stopping the offending drug and initiating TB treatment. There was no correlation with CD4 cell count and LN.
CONCLUSION
Lymphadenopathy is a common feature of acute DRESS, even among HIV-TB-coinfected patients with advanced immunosuppression.
背景
伴有嗜酸性粒细胞增多和全身症状的药物反应（DRESS）的RegiSCAR验证标准包括淋巴结病，这是结核病（TB）和人类免疫缺陷病毒（HIV）感染的常见特征。结核病是最常见的与HIV相关的合并感染。晚期HIV与淋巴结（LN）纤维化有关。目前尚不清楚这是否会对HIV相关的DRESS病例验证产生负面影响。为了回答这个问题，我们设计了一项前瞻性描述性研究，以评估合并HIV、TB和DRESS的各种组合中的淋巴结病。
目的
我们试图描述DRESS相关淋巴结病的患病率，并随着时间的推移，在HIV-TB负担较高的环境中，对淋巴结的质量、大小和分布进行特征描述。
方法
我们对南非一家三级护理中心收治的25例连续急性DRESS病例和10例住院的非DRESS HIV-TB合并感染对照进行了前瞻性和系统性的淋巴结检查。
结果
25例患者中有14例（56%）感染了HIV，CD4细胞计数中位数（四分位间距）为254（66-478）个细胞/mm³，14例中有7例合并感染了TB。根据RegiSCAR标准，25例中有12例（46%）为确诊DRESS病例，25例中有8例（31%）可能为DRESS病例，25例中有5例（23%）可能为DRESS病例。分析中排除了可能的病例。20名受试者中有15名（75%）在≥2个解剖部位有淋巴结，包括所有7例HIV-TB合并感染患者。相比之下，5例住院的非DRESS HIV-TB合并感染对照中有1例（20%）有淋巴结。17例中有15例（88%）颈部淋巴结最常见，其次是腋窝淋巴结（76%）和腹股沟淋巴结（59%）。颈部淋巴结大小在1至2厘米之间。在25例有随访数据的受试者中，8例（32%）在停用致病药物并开始抗结核治疗后的6周内，所有淋巴结均消退。淋巴结与CD4细胞计数之间无相关性。
结论
淋巴结病是急性DRESS的常见特征，即使在免疫抑制严重的HIV-TB合并感染患者中也是如此。
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