Immune reconstitution inflammatory syndrome presenting as chylothorax in a patient with HIV and Mycobacterium tuberculosis coinfection: a case report

BMC Infectious Diseases

Case Report

Jiun-Nong Lin¹  Chung-Hsu Lai²  Hsi-Hsun Lin³  Susan Shin-Jung Lee⁴  Lin-Li Chang⁵  Yen-Hsu Chen⁶ 

[1] Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan;Department of Critical Care Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan;Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan;Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan;Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan;Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan;Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan;Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan;Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan;Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan;Tropical Medicine Research Institute, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan;Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan;

关键词: Human Immunodeficiency Virus;    Thoracic Duct;    Immune Reconstitution Inflammatory Syndrome;    Chylous Ascites;    Methylene Diphosphonate;   

DOI  :  10.1186/1471-2334-10-321

 received in 2010-06-30, accepted in 2010-11-08,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundPatients with human immunodeficiency virus (HIV) infection are at risk for Mycobacterium tuberculosis (TB) coinfection. The advent of antiretroviral therapy restores immunity in HIV-infected patients, but predisposes patients to immune reconstitution inflammatory syndrome (IRIS).Case PresentationA 25-year-old HIV-infected male presented with fever, productive cough, and body weight loss for 2 months. His CD4 cell count was 11 cells/μl and HIV-1 viral load was 315,939 copies/ml. Antituberculosis therapy was initiated after the diagnosis of pulmonary TB. One week after antituberculosis therapy, antiretroviral therapy was started. However, multiple mediastinal lymphadenopathies and chylothorax developed. Adequate drainage of the chylothorax, suspension of antiretroviral therapy, and continued antituberculosis therapy resulted in successful treatment and good outcome.ConclusionsChylothorax is a rare manifestation of TB-associated IRIS in HIV-infected patients. Careful monitoring for development of IRIS during treatment of HIV-TB coinfection is essential to minimize the associated morbidity and mortality.

【 授权许可】

CC BY   
© Lin et al; licensee BioMed Central Ltd. 2010