Manifestation of an Abdominal Immune Reconstitution Inflammatory Syndrome Associated with a Nontuberculous Mycobacterial Infection – A Case Report

Abstract

Immune reconstitution inflammatory syndrome (IRIS) is an inflammatory reaction in HIV-infected patients after initiation of antiretroviral therapy. It results from restored immunity to specific infectious or non-infectious antigens. We describe the case of a 47-year-old female patient who presented with an unspecific painful pressure in the abdomen and weight loss that was diagnosed as intra-abdominal (unmasking) IRIS due to nontuberculous mycobacterial infection (Mycobacterium avium complex). Antiretroviral therapy had been initiated six months earlier when pneumocystis pneumonia led to the diagnosis of HIV infection with a viral load of 123 000 copies/ml and a CD 4 cell count of 6/µl. Although IRIS is a known complication after initiation of antiretroviral therapy in HIV-infected patients this case with a rare site of manifestation and symptoms that are common in all day gastroenterological clinic highlights a differential diagnosis that requires a high index of suspicion and the need for the careful use of diagnostic tools.

Zusammenfassung

Das immunrekonstitutionelle inflammatorische Syndrom (IRIS) ist durch eine entzündliche Immunreaktion charakterisiert, welche nach Einleitung einer antiretroviralen Therapie bei HIV-Patienten auftritt. Es resultiert aus der zurückgewonnenen Immunität gegenüber Infektionserregern oder nichtinfektiöser Antigene. Wir beschreiben den Fall einer 47-jährigen Patientin, die sich mit unspezifischen drückenden Bauchschmerzen und Gewichtsverlust vorstellte, die Folgen eines intraabdominellen (demaskierenden) IRIS aufgrund einer nicht tuberkulösen Mykobakteriose (Mycobacterium avium complex) waren. Sechs Monate zuvor war eine antiretrovirale Therapie eingeleitet worden, nachdem bei der Patientin im Rahmen einer Pneumozystis-Pneumonie eine HIV-Infektion (Stadium C3, Viruslast 123 000 Kopien/ml, CD-4 Zellzahl 6/µl) erstdiagnostiziert worden war. Obwohl das IRIS eine bekannte Komplikation nach Einleitung der antiretroviralen Therapie bei HIV-Patienten ist, beleuchtet dieser Fall mit einer seltenen intraabdominellen Manifestation und Beschwerden, die wir tagtäglich in unserer gastroenterologischen Klinik erleben, eine Differenzialdiagnose, an die gedacht werden muss und die eine sorgfältige Wahl der diagnostischen Verfahren erfordert.

Schlüsselwörter

immunrekonstitutionelles inflammatorisches Syndrom (IRIS) - nicht tuberkulöse Mykobakteriose - Mycobacterium avium complex

Key words

immune reconstitution inflammatory syndrome - nontuberculous mycobacterial infection - mycobacterium avium complex

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