title: [Pseudotumoral abdominal granuloma concomitant with immune reconstitution after antiretroviral treatment].
abstract: BACKGROUND
  Use of powerful multiple-drug antiretroviral regimens can significantly raise CD4+ counts restoring immune function, but in certain cases, leading to inflammatory reactions.
  
  
  METHODS
  An HIV-infected patient developed a mycobacteriosis of the digestive tract when his CD4 count fell below 5/mm3. He was given antimycobacterial treatment in combination with an effective triple antiretroviral regimen. At two years, the clinical situation was controlled with persistent optimal response (CD4 = 338/mm3 HIV-RNA < 500 copies/ml); the antimycobacterial regimen was discontinued. One year later the patient still had a CD4+ count above 500/mm3 but developed a voluminous mesenteric mass invaded by a CD68+ histiocyte proliferation. No causal agent could be identified. The clinical course was favorable after reintroducing antimycobacterial treatment combined with short-term corticosteroid therapy.
  
  
  CONCLUSIONS
  Reconstitution of the immune system after long-term use of the new antiretroviral therapies raises the question of whether anti-infectious prophylaxis should be maintained. However, possible reactions to earlier pathogens after restoration of specific immunity would warrant secondary prophylaxis even in patients responding to powerful antiretroviral combinations.
authors.affiliation: Service des Maladies infectieuses et tropicales, Hôpital Saint-Antoine, Paris. lfonq@club-internet.fr
authors.forename: L
authors.initials: L
authors.lastname: Fonquernie
authors.forename: J L
authors.initials: JL
authors.lastname: Meynard
authors.forename: M
authors.initials: M
authors.lastname: Kirstetter
authors.forename: S
authors.initials: S
authors.lastname: Prévot
authors.forename: J C
authors.initials: JC
authors.lastname: Le Van
authors.forename: M C
authors.initials: MC
authors.lastname: Meyohas
authors.forename: J
authors.initials: J
authors.lastname: Frottier
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000276:immunology; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D001706:Biopsy; D018791:CD4 Lymphocyte Count; D017291:Clarithromycin / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D004977:Ethambutol / Q000627:therapeutic use; D005500:Follow-Up Studies; D006099:Granuloma / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology*; D006801:Humans; D008199:Lymphadenitis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D008297:Male; D008643:Mesentery / Q000473:pathology; D009162:Mycobacterium avium; D010532:Peritoneal Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D017828:Rifabutin / Q000627:therapeutic use; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014376:Tuberculosis / Q000188:drug therapy* / Q000276:immunology
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D019380:Anti-HIV Agents; D000904:Antibiotics, Antitubercular; D000995:Antitubercular Agents; D017828:Rifabutin; D004977:Ethambutol; D017291:Clarithromycin