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Tomaino MV, Barletta JA, Andreani M, Sisto A, Abusamra L, Guelfand L, Rolón MJ. Hemophagocytic lymphohistiocytosis secondary to AIDS-related histoplasmosis and visceral leishmaniasis. Int J STD AIDS 2022; 33:873-876. [PMID: 35775465 DOI: 10.1177/09564624221110986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hemophagocytic Lymphohistiocytosis (HLH) is a rare, highly aggressive syndrome involving dysregulated immune response. Most cases are secondary to underlying diseases including infections, autoimmune disorders and malignancies. The burden of disease of histoplasmosis and leishmaniosis associated with advanced HIV is still significant in low-and-middle income countries (LMIC). We present a case of histoplasmosis and leishmaniasis associated HLH in a man with an AIDS diagnosis.
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Affiliation(s)
- María V Tomaino
- Infectious Diseases Division, 62916Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Argentina
| | - José Ae Barletta
- Infectious Diseases Division, 62916Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Argentina
| | - Mariana Andreani
- Microbiology Section, 62916Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Argentina
| | - Alicia Sisto
- Infectious Diseases Division, 62916Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Argentina
| | - Lorena Abusamra
- Infectious Diseases Division, 62916Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Argentina
| | - Liliana Guelfand
- Microbiology Section, 62916Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Argentina
| | - María J Rolón
- Infectious Diseases Division, 62916Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires, Argentina
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Pérez-Rueda M, Hernández-Cabrera M, Francés-Urmeneta A, Angel-Moreno A, Pisos-Álamo E, Jaén-Sánchez N, Carranza-Rodríguez C, Pérez-Arellano JL. Immune Reconstitution Inflammatory Syndrome in HIV-Infected Immigrants. Am J Trop Med Hyg 2017; 97:1072-1077. [PMID: 28820685 DOI: 10.4269/ajtmh.16-0773] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Immune reconstitution inflammatory syndrome (IRIS) includes a group of potentially serious inflammatory processes that may be present in HIV-infected patients after initiating highly active antiretroviral therapy (HAART). Paradoxical IRIS is a worsening of symptoms, after an overwhelming response to a previously diagnosed opportunistic infection (OI); unmasking IRIS reveals a previously occult OI. The main objective of the study was to describe the epidemiological, clinical, and outcome data of HIV-infected immigrants, stratified according to high- or low-income countries of origin, who developed IRIS and to compare them with native-born Spanish patients. This retrospective study reviewed all patients with HIV infection admitted to the Unit of Infectious Diseases and Tropical Medicine between 1998 and 2014. IRIS was identified in 25/138 (18%) immigrant patients and 24/473 (5%) native-born Spanish patients infected with HIV. Most cases, 19/25 (76%), were of unmasking IRIS. The time elapsed between initiation of HAART and development of IRIS was significantly longer in patients with unmasking versus paradoxical IRIS. OIs, in particular due to mycobacteria, were the most frequently involved processes. Twenty percent of patients died. The comparison of immigrant and native-born patients found significant differences for both IRIS type (higher incidence of paradoxical forms among immigrants) and for the absence of malignancies in native-born patients. No significant differences were found when the data of immigrants from low- and high-income countries were compared.
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Affiliation(s)
- María Pérez-Rueda
- Internal Medicine, Hospital San Roque Maspalomas (HSRM), Gran Canaria, Spain
| | - Michele Hernández-Cabrera
- Unit of Infectious Diseases and Tropical Medicine, Hospital Universitario Insular de Gran Canaria (HUIGC), Las Palmas, Spain.,Department of Medical and Surgical Sciences, University of Las Palmas, Las Palmas, Spain
| | - Adela Francés-Urmeneta
- Unit of Infectious Diseases and Tropical Medicine, Hospital Universitario Insular de Gran Canaria (HUIGC), Las Palmas, Spain
| | | | - Elena Pisos-Álamo
- Unit of Infectious Diseases and Tropical Medicine, Hospital Universitario Insular de Gran Canaria (HUIGC), Las Palmas, Spain.,Department of Medical and Surgical Sciences, University of Las Palmas, Las Palmas, Spain
| | - Nieves Jaén-Sánchez
- Unit of Infectious Diseases and Tropical Medicine, Hospital Universitario Insular de Gran Canaria (HUIGC), Las Palmas, Spain.,Department of Medical and Surgical Sciences, University of Las Palmas, Las Palmas, Spain
| | - Cristina Carranza-Rodríguez
- Unit of Infectious Diseases and Tropical Medicine, Hospital Universitario Insular de Gran Canaria (HUIGC), Las Palmas, Spain.,Department of Medical and Surgical Sciences, University of Las Palmas, Las Palmas, Spain
| | - Jose-Luis Pérez-Arellano
- Department of Medical and Surgical Sciences, University of Las Palmas, Las Palmas, Spain.,Unit of Infectious Diseases and Tropical Medicine, Hospital Universitario Insular de Gran Canaria (HUIGC), Las Palmas, Spain
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Paradoxical reaction to antituberculosis therapy in a patient with lupus vulgaris. ACTAS DERMO-SIFILIOGRAFICAS 2015; 106:e7-e12. [PMID: 25089032 DOI: 10.1016/j.ad.2014.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 04/15/2014] [Accepted: 05/11/2014] [Indexed: 11/21/2022] Open
Abstract
Patients receiving treatment for tuberculosis may experience an unexpected deterioration of their disease; this is known as a paradoxical reaction. We present the case of a 59-year-old man with lupus vulgaris who experienced a paradoxical deterioration of cutaneous lesions after starting antituberculosis therapy. The reaction was self-limiting; the lesions gradually improved, and the final outcome was very good. Paradoxical reactions are well-known in patients with human immunodeficiency virus (HIV) infection who start antiretroviral therapy, but they can also occur in non-HIV-infected patients with tuberculosis who start antituberculosis therapy. In the literature reviewed, paradoxical reactions involving skin lesions were described in patients with miliary tuberculosis. The case we report is the first of a paradoxical reaction in lupus vulgaris. The increasing frequency of tuberculosis in Spain could lead to a rise in the number of paradoxical reactions.
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Paradoxical Reaction to Antituberculosis Therapy in a Patient With Lupus Vulgaris. ACTAS DERMO-SIFILIOGRAFICAS 2015. [DOI: 10.1016/j.adengl.2014.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Micosis sistémicas en pacientes con virus de la inmunodeficiencia humana/sida. ACTAS DERMO-SIFILIOGRAFICAS 2014; 105:5-17. [DOI: 10.1016/j.ad.2012.06.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 05/08/2012] [Accepted: 06/24/2012] [Indexed: 11/19/2022] Open
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Rodríguez-Cerdeira C, Arenas R, Moreno-Coutiño G, Vásquez E, Fernández R, Chang P. Systemic Fungal Infections in Patients with human inmunodeficiency virus. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.adengl.2012.06.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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