title: Acute kidney injury and inflammatory immune reconstitution syndrome in mixed genotype (A/E) hepatitis B virus co-infection in HIV-associated lymphoma.
abstract: We report a first case of HIV-associated lymphoma (HAL) presenting with acute kidney injury (AKI) and inflammatory immune reconstitution syndrome (IRIS). A 39-year-old male, treated with nonsteroidal anti-inflammatory drugs (NSAIDs) for one month prior to admission, developed AKI, left testicular tumor, and recurrent swelling of the right parotid gland. A resected testicular tumor exhibited features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma. Renal biopsy showed hydro-degeneration of renal tubules, interstitial inflammatory cells, and a small number of lymphoma cells in the sub-capsule, compatible with acute interstitial nephritis. His renal dysfunction rapidly recovered following chemotherapy and combination antiretroviral therapy (cART). He developed pneumonia concomitantly with a decrease in HIV-RNA level and an increase in CD4+ cells after the first cycle of chemotherapy, which spontaneously resolved after the second cycle of chemotherapy without additional anti-infection drugs; thus, his pneumonia fulfilled the diagnostic criteria for IRIS. We suggest that IRIS may frequently develop during chemotherapy for HAL, but may be overlooked. He was coinfected with hepatitis B virus (HBV), which genotypes known as is associated with liver-related mortality and response to antiviral therapy; recently, an intimate interplay between HIV and HBV in the onset of lymphoma has been reported. Therefore, we addressed the HBV genotype in the patient. The analysis revealed that he exhibited a mixed genotype (A/E) not native to Japan and primarily found in Europe and North America or West Africa. These findings suggest that universal vaccination for juveniles against HBV is warranted in Japan.
authors: Department of Radiation Emergency Medicine, National Institute of Radiological Sciences Chiba, Japan. tajima@nirs.go.jp
authors: Katsushi
authors: K
authors: Tajima
authors: Kei
authors: K
authors: Kohno
authors: Yosuke
authors: Y
authors: Shiono
authors: Ikuko
authors: I
authors: Suzuki
authors: Yuichi
authors: Y
authors: Kato
authors: Yuki
authors: Y
authors: Hiroshima
authors: Masakazu
authors: M
authors: Yamamoto
authors: Hiroya
authors: H
authors: Ohtake
authors: Akiko
authors: A
authors: Iwaba
authors: Mitsunori
authors: M
authors: Yamakawa
authors: Takeo
authors: T
authors: Kato
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications / Q000473:pathology*; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D060085:Coinfection / Q000188:drug therapy / Q000473:pathology* / Q000821:virology; D004279:DNA, Viral / Q000235:genetics; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy / Q000473:pathology* / Q000821:virology; D006509:Hepatitis B / Q000188:drug therapy / Q000473:pathology* / Q000821:virology; D006515:Hepatitis B virus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000473:pathology* / Q000821:virology; D016483:Lymphoma, AIDS-Related / Q000188:drug therapy / Q000473:pathology* / Q000821:virology; D008297:Male; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000821:virology; D016896:Treatment Outcome
chemical_list: D044966:Anti-Retroviral Agents; D004279:DNA, Viral
keywords: HIV; Hepatitis B virus; acute kidney injury; genotype; immune reconstitution inflammatory syndrome; ptosis