Crusted scabies-associated immune reconstitution inflammatory syndrome

BMC Infectious Diseases

Gustavo Reyes-Terán¹  Claudia Alvarado-de la Barrera¹  Marcela Saeb-Lima¹  Mónica Fernández-Sánchez¹ 

[1] Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Colonia Sección XVI, C.P. 14080, Delegación Tlalpan, México D.F

关键词: ART;    AIDS;    HIV;    IRIS;    Crusted scabies;   

Others  :  1158785
DOI  :  10.1186/1471-2334-12-323

 received in 2012-06-13, accepted in 2012-11-23,  发布年份 2012

【 摘 要 】

Background

Despite the widely accepted association between crusted scabies and human immunodeficiency virus (HIV)-infection, crusted scabies has not been included in the spectrum of infections associated with immune reconstitution inflammatory syndrome in HIV-infected patients initiating antiretroviral therapy.

Case presentation

We report a case of a 28-year-old Mexican individual with late HIV-infection, who had no apparent skin lesions but soon after initiation of antiretroviral therapy, he developed an aggressive form of crusted scabies with rapid progression of lesions. Severe infestation by Sarcoptes scabiei was confirmed by microscopic examination of the scale and skin biopsy. Due to the atypical presentation of scabies in a patient responding to antiretroviral therapy, preceded by no apparent skin lesions at initiation of antiretroviral therapy, the episode was interpreted for the first time as “unmasking crusted scabies-associated immune reconstitution inflammatory syndrome”.

Conclusion

This case illustrates that when crusted scabies is observed in HIV-infected patients responding to antiretroviral therapy, it might as well be considered as a possible manifestation of immune reconstitution inflammatory syndrome. Patient context should be considered for adequate diagnosis and treatment of conditions exacerbated by antiretroviral therapy-induced immune reconstitution.

【 授权许可】

   
2012 Fernández-Sánchez et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Walton SF: The immunology of susceptibility and resistance to scabies. Parasite Immunol 2010, 32:532-540.
• [2]Schlesinger I, Oelrich DM, Tyring SK: Crusted (Norwegian) scabies in patients with AIDS: The range of clinical presentations. South Med J 1996, 87:352-356.
• [3]Orkin M: Scabies in AIDS. Semin Dermatol 1993, 12:9-14.
• [4]Müller M, Wandel S, Colebunders R, Attia S, Furrer H, Egger M: Immune reconstitution inflammatory syndrome in patients starting antiretroviral therapy for HIV infection: a systematic review and meta-analysis. Lancet Infect Dis 2010, 10:251-261.
• [5]French MA, Price P, Stone SF: Immune restoration disease after antiretroviral therapy. AIDS 2004, 18:1615-1627.
• [6]Meintjes G, Lawn SD, Scano F, Maartens G, French MA, Worodria W, Elliott JH, Murdoch D, Wilkinson RJ, Seyler C, John L, van der Loeff MS, Reiss P, Lynen L, Janoff EN, Gilks C, Colebunders R, International Network for the Study of HIV-associated IRIS: Tuberculosis-associated immune reconstitution inflammatory syndrome: case definitions for use in resource-limited settings. Lancet Infect Dis 2008, 8:516-523.
• [7]Sirera G, Rius F, Romeu J, Llibre J, Ribera M, Soriano V, Tor J, Ferrandiz C, Clotet B: Hospital outbreak of scabies stemming from two AIDS patients with Norwegian scabies. Lancet 1990, 335:1227.
• [8]Murdoch DM, Venter WD, Van Rie A, Feldman C: Immune reconstitution inflammatory syndrome (IRIS): review of common infectious manifestations and treatment options. AIDS Research and Therapy 2007, 4:9. http://www.aidsrestherapy.com/content/pdf/1742-6405-4-9.pdf webcite. BioMed Central Full Text
• [9]Jiménez-Expósito MJ, Alonso-Villaverde C, Sardà P, Masana L: Visceral leishmaniasis in HIV-infected patients with non-detectable HIV-1 viral load after highly active antiretroviral therapy. AIDS 1999, 13:152-153.
• [10]Lanzafame M, Faggian F, Lattuada E, Antolini D, Vento S: Strongyloidiasis in an HIV-1-infected patient after highly active antiretroviral therapy-induced immune restoration. J Infect Dis 2005, 191:1027.
• [11]de Silva S, Walsh J, Brown M: Symptomatic Schistosoma mansoni infection as an immune restoration phenomenon in a patient receiving antiretroviral therapy. Clin Infect Dis 2006, 42:303-304.
• [12]Tsambiras PE, Larkin JA, Houston SH: Case report. Toxoplasma encephalitis after initiation of HAART. AIDS Read 2001, 11:615-616.