Inflammatory bowel perforation during immune restoration after one year of antiretroviral and antituberculous therapy in an HIV-1-infected patient: report of a case.
OBJECTIVE
This article reports an unusual presentation of bowel perforation.


METHODS
We report the case of a 30-year-old HIV-infected male who suffered from an advanced state of CD4 cell depletion (29 CD4 cells per 106/l). Abdominal pain and diarrhea led to further examinations.


RESULTS
Colonoscopy revealed a severe tuberculous ileocecal inflammation. Tuberculosis and HIV infection were treated. The patient's response to antiretroviral therapy was excellent. After 11 months of potent antiretroviral treatment and 12 months of antituberculous therapy he suffered from acute abdominal pain with fever and ileus. Laparotomy revealed two intestinal perforations of the jejunum and inflammation of the whole ileocecal region.


CONCLUSIONS
Immunopathologic reactions caused by immune restoration are novel presentations of highly active antiretroviral treatment as shown here. The presented patient is an unusual case with a very late onset of inflammatory response, which led to intestinal perforation.
Basel Center for HIV Research, Outpatient Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
Anne-Catherine
AC
Guex
Heiner C
HC
Bucher
Nicolas
N
Demartines
Ursula
U
Flückiger
Manuel
M
Battegay
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000276:immunology*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D000995:Antitubercular Agents / Q000009:adverse effects*; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology*; D015497:HIV-1; D006801:Humans; D007249:Inflammation / Q000209:etiology; D007416:Intestinal Perforation / Q000209:etiology*; D007579:Jejunal Diseases / Q000209:etiology*; D008297:Male; D014385:Tuberculosis, Gastrointestinal / Q000188:drug therapy / Q000276:immunology
D000995:Antitubercular Agents