Fetal death as a result of placental immune reconstitution inflammatory syndrome.
A 26-year-old woman was HIV-1 diagnosed at 11 weeks of pregnancy (CD4 = 7/mm(3), HIV-1 RNA = 108,000 copies/mL) with immunity against toxoplasmosis (Toxoplasma IgG = 1800 UI/mL). A fetal death was diagnosed 7 weeks after starting HAART (CD4 = 185/mm(3), HIV-1 RNA = 391 copies/mL) with a positive Toxoplasma PCR on fetal tissues and amniotic fluid. The absence of severe toxoplasmic foetopathy, the very exaggerated and atypical placental inflammation and the immune restoration context led to the diagnosis of placental IRIS associated with Toxoplasma gondii reactivation. This outcome remains undescribed and could represent an issue in resource-limited settings where HIV-pregnant patients are often severely immunodeficient and infected with opportunistic pathogens.
Caby
F
F
Service des Maladies Infectieuses et Tropicales, Groupe Hospitalier Pitié-Salpêtrière, Assistance publique des hôpitaux de Paris (AP-HP), Paris, France. fabienne.caby@psl.aphp.fr
Lemercier
D
D
Coulomb
A
A
Grigorescu
R
R
Paris
L
L
Touafek
F
F
Carcelain
G
G
Canestri
A
A
Pauchard
M
M
Katlama
C
C
Dommergues
M
M
Tubiana
R
R
D000328:Adult; D000653:Amniotic Fluid / Q000469:parasitology; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D018791:CD4 Lymphocyte Count; D016054:DNA, Protozoan / Q000302:isolation & purification; D005260:Female; D005313:Fetal Death; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000150:complications / Q000175:diagnosis*; D010920:Placenta / Q000473:pathology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D012367:RNA, Viral / Q000097:blood; D014122:Toxoplasma / Q000302:isolation & purification; D014123:Toxoplasmosis / Q000150:complications* / Q000175:diagnosis* / Q000469:parasitology; D019562:Viral Load
D019380:Anti-HIV Agents; D016054:DNA, Protozoan; D012367:RNA, Viral