[Focal mycobacterial lymphadenitis after starting highly active antiretroviral therapy].
METHODS
A 30-year-old man with a known HIV infection for 7 years presented for treatment with antiretroviral drugs. He was known to have had herpes zoster, oral hairy leukoplakia and recurrent Candida stomatitis, but was otherwise without symptoms.


METHODS
The CD4 lymphocyte count was 19 cells/mm3 and there were 41,000 HIV-RNA copies/ml.


METHODS
The HIV infection was in CDC stage B3, indicating the need for combined antiretroviral treatment. A week after starting stavudine, saquinavir and ritonavir he had to be admitted because of nausea and vomiting, colicky abdominal pain, diarrhea, fever up to 39 degrees C and a rise of C-reactive protein to 207 mg/dl. Bacteriological examination of feces and biopsy of an enlarged retroperitoneal lymph node revealed atypical mycobacteria. Antituberculosis treatment was started. The CD4 cell count rose to 56/mm3 and the viral count fell to 11,000/ml. Each time after initiating a different antiviral regimen the symptoms recurred.


CONCLUSIONS
This case illustrates an atypical manifestation of on opportunistic infection: during combined antiviral treatment the CD4 cell count rose and thus precipitated an heretofore subclinical mycobacterial infection with focal lymphadenitis. If, on starting antiretroviral treatment at a late HIV stage, new symptoms develop within 1-3 weeks, one should consider drug-induced side effects or the onset of an opportunistic infection that has become manifest as the result of an improved immunological state.
Schwietert
M
M
Medizinische Universitäts-Poliklinik, Kantonsspital Basel.
Battegay
M
M
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000995:Antitubercular Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008199:Lymphadenitis / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008640:Mesenteric Lymphadenitis / Q000175:diagnosis / Q000209:etiology; D015270:Mycobacterium avium-intracellulare Infection / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D019438:Ritonavir / Q000008:administration & dosage / Q000009:adverse effects*; D019258:Saquinavir / Q000008:administration & dosage / Q000009:adverse effects*; D018119:Stavudine / Q000008:administration & dosage / Q000009:adverse effects*; D013997:Time Factors; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*