Graves' disease after interleukin-2 therapy in a patient with human immunodeficiency virus infection.
Interleukin-2 (IL-2) is a cytokine that regulates the proliferation and differentiation of lymphocytes, and is currently used clinically in the treatment of assorted malignancies. Additionally, IL-2 is being actively investigated in clinical trials for treatment of human immunodeficiency virus (HIV) infection. Patients treated with IL-2 are susceptible to autoimmune thyroid disease (AITD), presenting as thyroiditis, which leads to either thyrotoxicosis or hypothyroidism, if not correctly and promptly identified and treated. IL-2-induced hypothyroidism can also sometimes follow a thyrotoxic phase. However, the development of Graves' disease (GD) in this clinical setting has not been reported to date. Here, we report the case of a 39-year-old HIV-infected man in whom GD developed after IL-2 therapy. We correlated the immunologic parameters pertinent to the patient's HIV infection status with clinical, hormonal, and serologic evidence of GD during its emergence. This revealed an association between peripheral blood cell numbers of specific lymphocyte subpopulations (CD4(+), CD3(+)CD25(+), and naïve T-cells) and serum levels of markers for AITD (free thyroxine [T(4)] and thyroid-stimulating immunoglobulin). Interestingly, no association was found between natural killer (NK) cell numbers and AITD markers. The immunopathogenesis of GD in this patient may be similar to that hypothesized for the GD that occurs in immune-reconstituted patients after combination antiretroviral therapy. From a practical standpoint, we propose that patients who have received or are receiving treatment with IL-2 who show signs of hyperthyroidism need to be carefully evaluated for GD.
Jimenez
Camilo
C
Joint Endocrinology, Diabetes & Metabolism Fellowship at Baylor College of Medicine/The University of Texas-M.D. Anderson Cancer Center, Houston 77030, USA.
Moran
Stephanie A
SA
Sereti
Irini
I
Wynne
Sarah
S
Yen
Paul M
PM
Falloon
Judith
J
Davey
Richard T
RT
Sarlis
Nicholas J
NJ
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications; D000328:Adult; D015704:CD4 Antigens; D006111:Graves Disease / Q000139:chemically induced*; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D018828:Immunoglobulins, Thyroid-Stimulating / Q000627:therapeutic use; D007376:Interleukin-2 / Q000627:therapeutic use*; D007694:Killer Cells, Natural / Q000276:immunology; D008297:Male; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood
D015704:CD4 Antigens; D018828:Immunoglobulins, Thyroid-Stimulating; D007376:Interleukin-2; D013972:Thyrotropin; D013974:Thyroxine