title: A rare case of immune reconstitution inflammatory syndrome presenting as secondary syphilis.
abstract: Immune reconstitution syndrome has rarely been reported in the context of syphilis infection. We report a patient with AIDS (CD4 42 cells/mm(3), viral load 344,000 cp/ml), treated previously for secondary syphilis and started on an integrase inhibitor-based single-tablet antiretroviral treatment regimen. After four weeks of antiretroviral treatment, he presented with non-tender, non-blanching erythematous nodules on his chest, an elevated rapid plasma reagin (1:1024) and immune reconstitution (CD4 154 cells/mm(3), HIV-RNA 130 cp/ml). A detailed workup to exclude opportunistic infections including secondary and neurosyphilis was performed. The patient was continued on antiretroviral treatment and treated empirically for neurosyphilis given cerebrospinal lymphocytosis and dermatopathology suggesting treponemal antigen-driven B-cell hyperplasia. We favour a diagnosis of immune reconstitution in association with prior syphilis infection attributable to rapid and potent immune restoration afforded by integrase inhibitors.
authors.affiliation: Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA Department of Medicine, Case Medical Center, Cleveland, OH, USA.
authors.forename: Asma
authors.initials: A
authors.lastname: Khatri
authors.affiliation: Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA Case Western Reserve University School of Medicine, Cleveland, OH, USA marion.skalweit@va.gov.
authors.forename: Marion J
authors.initials: MJ
authors.lastname: Skalweit
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D003937:Diagnosis, Differential; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000150:complications* / Q000276:immunology; D008297:Male; D013587:Syphilis / Q000175:diagnosis* / Q000382:microbiology; D013588:Syphilis Serodiagnosis; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents
keywords: AIDS; HIV integrase inhibitors; Human immunodeficiency virus; IRIS; Treponema pallidum; antiretroviral therapy; immune reconstitution syndrome; syphilis