Clinical features and management of a severe paradoxical reaction associated with combined treatment of Buruli ulcer and HIV co-infection

BMC Infectious Diseases

Daniel P O’Brien⁴  Vanessa Christinet¹  Isabelle Masouyé³  Laurence Toutous Trellu³  Eric Comte¹  Marie Tchaton²  Genevieve Ehounou²  Patrick Nkemenang²  Franck Wanda² 

[1] Medical Unit, Médecins Sans Frontières, Geneva, Switzerland;Médecins Sans Frontières, Akonolinga, Cameroon;Department of Dermatology, University Hospitals of Geneva, Geneva, Switzerland;Department of Medicine and Infectious Diseases, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia

关键词: Prednisolone;    Antiretroviral treatment;    Antibiotics;    Paradoxical reaction;    HIV;    Buruli ulcer;    Mycobacterium ulcerans;   

Others  :  1127254
DOI  :  10.1186/1471-2334-14-423

 received in 2014-03-21, accepted in 2014-07-15,  发布年份 2014

【 摘 要 】

Background

In West and Central Africa Buruli ulcer (BU) and HIV co-infection is increasingly recognised and management of these two diseases combined is an emerging challenge for which there is little published information. In this case we present a severe paradoxical reaction occurring after commencing antibiotic treatment for BU combined with antiretroviral therapy for HIV, and describe its clinical features and management. This includes to our knowledge the first reported use of prednisolone in Africa to manage a severe paradoxical reaction related to BU treatment.

Case presentation

A 30 year old immunosuppressed HIV positive man from Cameroon developed a severe paradoxical reaction 24 days after commencing antibiotic treatment for BU and 14 days after commencing antiretroviral therapy for HIV. Oral prednisolone was successfully used to settle the reaction and prevent further tissue loss. The antiretroviral regimen was continued unchanged and the BU antibiotic treatment not prolonged beyond the recommended duration of 8 weeks. A second small local paradoxical lesion developed 8 months after starting antibiotics and settled with conservative treatment only. Complete healing of lesions occurred and there was no disease recurrence 12 months after commencement of treatment.

Conclusions

Clinicians should be aware that severe paradoxical reactions can occur during the treatment of BU/HIV co-infected patients. Prednisolone was effectively and safely used to settle the reaction and minimize the secondary tissue damage.

【 授权许可】

   
2014 Wanda et al.; licensee BioMed Central Ltd.

【 图 表 】

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