HIV-positive patient with herpes zoster: a manifestation of the immune reconstitution inflammatory syndrome.
Herpes zoster is a common illness that can lead to serious morbidity. There is now evidence that HIV-infected patients who have been treated with antiretroviral therapy are at greater risk of developing herpes zoster not when they are severely immunocompromised but, paradoxically, when their immune system is recovering. This is a manifestation of the immune reconstitution inflammatory syndrome. The objectives of this report are to (1) inform health care providers that HIV-infected patients may develop multiple infectious, autoimmune, and oncological manifestations after treatment with antiretroviral medication, as they have immune system reconstitution, and (2) discuss herpes zoster, one of the possible manifestations. The patient is a 68-year-old HIV-positive man who presented with herpes zoster after being treated with highly active antiretroviral therapy (HAART) when his immune system was recovering, not when he was most immunosuppressed. Emergency department physicians should be aware that HIV-infected patients treated with HAART may have clinical deterioration despite immune system strengthening. This immune reconstitution inflammatory syndrome can present with infectious, autoimmune, or oncological manifestations. Our case patient, an HIV-positive man with immune system recovery after treatment with HAART, presented with an infectious manifestation, herpes zoster.
Department of Emergency Medicine, NYU School of Medicine, and VA New York Harbor Healthcare Center, New York, NY 10010, USA. nancy.lutwak@va.gov
Nancy
N
Lutwak
Curt
C
Dill
D000208:Acute Disease; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D000998:Antiviral Agents / Q000627:therapeutic use; D004636:Emergency Service, Hospital; D005076:Exanthema / Q000150:complications / Q000175:diagnosis / Q000821:virology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D006562:Herpes Zoster / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000150:complications* / Q000276:immunology / Q000821:virology; D008297:Male
D019380:Anti-HIV Agents; D000998:Antiviral Agents