Mit dem Skalpell gegen das Immunsystem: eine unklare Kolitis bei HIV-Infektion

Zusammenfassung

Eine 35-jährige Kenianerin begann aufgrund einer fortgeschrittenen HIV-Infektion mit einer antiretroviralen Therapie. Fünf Monate später wurde eine ausgeprägte Kolitis diagnostiziert, ohne dass ein Erreger nachweisbar war. Bei Perforationsgefahr erfolgte eine Hemikolektomie, wodurch sich Symptome und Entzündungsparameter sofort normalisierten. Erst in der Kultur aus einem intestinalen Lymphknoten konnte M. tuberculosis nachgewiesen werden. Als Ursache der Kolitis kommt am ehesten ein Immunrekonstitutionssyndrom (IRIS) infrage. Diagnose, Pathogenese und Therapie des IRIS werden diskutiert.

Abstract

A 35-year-old Kenian lady with advanced immunodeficiency due to HIV infection started on an antiretroviral therapy. Five months later, a severe colitis was diagnosed, however, no causal pathogen could be found. In order to avoid imminent perforation, a hemicolectomy became necessary, and immediately the symptoms and inflammation markers normalized rapidly. M. tuberculosis could be proven in culture in a draining abdominal lymph node. We assume that the severe inflammation was caused by an immune restoration inflammatory syndrome (IRIS). Essentials in diagnosis, pathogenesis and therapy of IRIS are discussed.

Schlüsselwörter

HIV - Tuberkulose - Immunrekonstitutionssyndrom - IRIS - Kolitis

Key words

HIV - tuberculosis - immune restoration inflammatory syndrome - IRIS - colitis

Literatur

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