Tegumentary leishmaniasis as the cause of immune reconstitution inflammatory syndrome in a patient co-infected with human immunodeficiency virus and Leishmania guyanensis.
We report a case of immune reconstitution inflammatory syndrome (IRIS) in a 32-year-old man infected with human immunodeficiency virus and Leishmania guyanensis. Three months after initiation of highly active anti-retroviral therapy (HAART), the patient had disseminated cutaneous leishmaniasis and started anti-leishmanial therapy. The patient's leishmaniasis manifestations during HAART ranged form an anergic response (46 CD4+ T cells/microL) to a disseminated cutaneous leishmaniasis (112 CD4+ T cells/microL). Eight weeks later (168 CD4+ T cells/microL, skin biopsy specimens showed inflammatory infiltrates with no detectable amastigotes. The patient then became comatose. Prednisone therapy (60 mg/day) was initiated with a significant improvement within 48 hours. Three months later (CD4+ T cell count = 184 cell/microL), localized, classic, cutaneous leishmaniasis developed in the patient and anti-leishmanial treatment was re-introduced. On that occasion, frequency of T regulatory cells was 1.82% of all CD4+ cells. Our data suggest a pivotal role for CD4+ T cells in the onset of IRIS and lesion ulceration and their association with a low frequency of T regulatory cells.
Chrusciak-Talhari
Anette
A
Fundação de Medicina Tropical do Amazonas, Manaus, Amazonas, Brazil.
Ribeiro-Rodrigues
Rodrigo
R
Talhari
Carolina
C
Silva
Roberto Moreira
RM
Ferreira
Luis Carlos de Lima
LC
Botileiro
Simone Ferreira de Castro
SF
Santos
Lucilaide Oliveira
LO
Dietze
Reynaldo
R
Talhari
Sinésio
S
D000328:Adult; D000818:Animals; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000150:complications* / Q000188:drug therapy / Q000469:parasitology / Q000821:virology; D018334:Leishmania guyanensis; D007897:Leishmaniasis, Mucocutaneous / Q000150:complications* / Q000188:drug therapy / Q000469:parasitology*; D008297:Male; D011241:Prednisone / Q000627:therapeutic use; D012867:Skin / Q000473:pathology
D000890:Anti-Infective Agents; D000893:Anti-Inflammatory Agents; D011241:Prednisone