title: Tegumentary leishmaniasis as the cause of immune reconstitution inflammatory syndrome in a patient co-infected with human immunodeficiency virus and Leishmania guyanensis.
abstract: 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.
authors.affiliation: Fundação de Medicina Tropical do Amazonas, Manaus, Amazonas, Brazil.
authors.forename: Anette
authors.initials: A
authors.lastname: Chrusciak-Talhari
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Ribeiro-Rodrigues
authors.forename: Carolina
authors.initials: C
authors.lastname: Talhari
authors.forename: Roberto Moreira
authors.initials: RM
authors.lastname: Silva
authors.forename: Luis Carlos de Lima
authors.initials: LC
authors.lastname: Ferreira
authors.forename: Simone Ferreira de Castro
authors.initials: SF
authors.lastname: Botileiro
authors.forename: Lucilaide Oliveira
authors.initials: LO
authors.lastname: Santos
authors.forename: Reynaldo
authors.initials: R
authors.lastname: Dietze
authors.forename: Sinésio
authors.initials: S
authors.lastname: Talhari
mesh_terms: 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
chemical_list: D000890:Anti-Infective Agents; D000893:Anti-Inflammatory Agents; D011241:Prednisone