Immune reconstitution inflammatory syndrome due to Mycobacterium avium complex successfully followed up using18 F-fluorodeoxyglucose positron emission tomography-computed tomography in a patient with human immunodeficiency virus infection: A case report

BMC Medical Imaging

Naoki Hasegawa²  Tomoko Betsuyaku³  Sadatomo Tasaka³  Koichi Fukunaga³  Fumitake Saito³  Takahiro Asami³  Takanori Asakura³  Shoji Suzuki³  Masako Matsusaka³  Mizuha Haraguchi³  Kazuma Yagi³  Makoto Ishii³  Hiroshi Fujiwara²  Ho Namkoong¹ 

[1] Japan Society for the Promotion of Science, Tokyo, Japan;Center for Infectious Diseases and Infection Control, Keio University School of Medicine, Tokyo, Japan;Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku 160-8582, Tokyo, Japan

关键词: 18 F-fluorodeoxyglucose positron emission tomography/computed tomography;    Mycobacterium avium complex;    Nontuberculous mycobacteria;    Human immunodeficiency virus;    Immune reconstitution inflammatory syndrome;   

Others  :  1220822
DOI  :  10.1186/s12880-015-0063-2

 received in 2015-01-28, accepted in 2015-06-02,  发布年份 2015

【 摘 要 】

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.¹⁸  F-fluorodeoxyglucose positron emission tomography/computed tomography ( ¹⁸  F-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 using¹⁸  F-FDG PET/CT.

Case presentation

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.¹⁸  F-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.

Conclusion

We present a case of MAC-IRIS in an HIV-infected patient whose disease activity was successfully followed up using¹⁸  F-FDG PET/CT. Our data suggest that¹⁸  F-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.

【 授权许可】

   
2015 Namkoong et al.

【 图 表 】

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