[Pseudotumoral abdominal granuloma concomitant with immune reconstitution after antiretroviral treatment].
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.
Fonquernie
L
L
Service des Maladies infectieuses et tropicales, Hôpital Saint-Antoine, Paris. lfonq@club-internet.fr
Meynard
J L
JL
Kirstetter
M
M
Prévot
S
S
Le Van
J C
JC
Meyohas
M C
MC
Frottier
J
J
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
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D019380:Anti-HIV Agents; D000904:Antibiotics, Antitubercular; D000995:Antitubercular Agents; D017828:Rifabutin; D004977:Ethambutol; D017291:Clarithromycin