title: Immune reconstitution inflammatory syndrome due to Mycobacterium avium complex successfully followed up using 18 F-fluorodeoxyglucose positron emission tomography-computed tomography in a patient with human immunodeficiency virus infection: A case report.
abstract: BACKGROUND
  In human immunodeficiency virus (HIV)-infected patients, immune reconstitution inflammatory syndrome (IRIS) due to nontuberculous mycobacteria (NTM) infection is one of the most difficult types of IRIS to manage. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has been suggested as a useful tool for evaluating the inflammatory status of HIV-infected patients. We present the first case of Mycobacterium avium complex (MAC)-associated IRIS (MAC-IRIS) that was successfully followed up using 18F-FDG PET/CT.
  
  
  METHODS
  A 44-year-old homosexual Japanese man was referred to our hospital with fever and dyspnea. He was diagnosed with Pneumocystis jiroveci pneumonia and found to be HIV positive. After the initiation of combined antiretroviral therapy (cART), the patient's mediastinal and bilateral hilar lymphadenopathy gradually enlarged, and bilateral infiltrates appeared in the upper lung fields. 18F-FDG PET/CT was performed five months after the initiation of cART and showed intense accumulation of fluorodeoxyglucose (FDG) corresponding to the lesions of infiltration as well as the mediastinal and bilateral hilar lymphadenopathy. A bronchial wash culture and pathology findings led to a diagnosis of MAC-IRIS. Anti-mycobacterial chemotherapy with rifampicin, ethambutol, clarithromycin, and levofloxacin was started. One year after the chemotherapy was initiated, there was a significant reduction in FDG uptake in the area of the lesions except in the mediastinal lymph node. This implied incomplete resolution of the MAC-IRIS-related inflammation. Anti-mycobacterial chemotherapy was continued because of the residual lesion. To date, the patient has not experienced a recurrence of MAC-IRIS, a period of nine months.
  
  
  CONCLUSIONS
  We present a case of MAC-IRIS in an HIV-infected patient whose disease activity was successfully followed up using 18F-FDG PET/CT. Our data suggest that 18F-FDG PET/CT is useful for evaluating the disease activity of NTM-IRIS and assessing the appropriate duration of anti-mycobacterial chemotherapy for NTM-IRIS in HIV-infected patients.
authors.affiliation: Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. hounamugun@gmail.com.|Japan Society for the Promotion of Science, Tokyo, Japan. hounamugun@gmail.com.
authors.forename: Ho
authors.initials: H
authors.lastname: Namkoong
authors.affiliation: Center for Infectious Diseases and Infection Control, Keio University School of Medicine, Tokyo, Japan. lecafe1979@yahoo.co.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fujiwara
authors.affiliation: Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. ishii@z6.keio.jp.
authors.forename: Makoto
authors.initials: M
authors.lastname: Ishii
authors.affiliation: Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. kazumayagi1214@yahoo.co.jp.
authors.forename: Kazuma
authors.initials: K
authors.lastname: Yagi
authors.affiliation: Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. mizuha-h@rf7.so-net.ne.jp.
authors.forename: Mizuha
authors.initials: M
authors.lastname: Haraguchi
authors.affiliation: Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. apfel0110@gmail.com.
authors.forename: Masako
authors.initials: M
authors.lastname: Matsusaka
authors.affiliation: Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. shojis221@gmail.com.
authors.forename: Shoji
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. takanori.asakura@gmail.com.
authors.forename: Takanori
authors.initials: T
authors.lastname: Asakura
authors.affiliation: Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. asamitakahiro@gmail.com.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Asami
authors.affiliation: Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. fumitake.cpnet@gmail.com.
authors.forename: Fumitake
authors.initials: F
authors.lastname: Saito
authors.affiliation: Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. k-fuku@jf7.so-net.ne.jp.
authors.forename: Koichi
authors.initials: K
authors.lastname: Fukunaga
authors.affiliation: Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. tasaka@cpnet.med.keio.ac.jp.
authors.forename: Sadatomo
authors.initials: S
authors.lastname: Tasaka
authors.affiliation: Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. tbetsuyaku@z5.keio.jp.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Betsuyaku
authors.affiliation: Center for Infectious Diseases and Infection Control, Keio University School of Medicine, Tokyo, Japan. n-hasegawa@z8.keio.jp.
authors.forename: Naoki
authors.initials: N
authors.lastname: Hasegawa
mesh_terms: D000328:Adult; D019788:Fluorodeoxyglucose F18; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000175:diagnosis* / Q000209:etiology* / Q000382:microbiology; D008297:Male; D064847:Multimodal Imaging / Q000379:methods; D015270:Mycobacterium avium-intracellulare Infection / Q000150:complications* / Q000175:diagnosis* / Q000382:microbiology; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18