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Górecka A, Majewski S, Szymańska E, Walecka I. Skin and mucosal manifestations of immune reconstitution inflammatory syndrome in people living with HIV: a review. Int J Dermatol 2024; 63:852-857. [PMID: 38426349 DOI: 10.1111/ijd.17082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/15/2024] [Accepted: 01/29/2024] [Indexed: 03/02/2024]
Abstract
Opportunistic infections have significantly decreased in individuals living with human immunodeficiency virus and receiving antiretroviral therapy. However, in approximately 10%-25% of patients, severe skin reactions during immune reconstruction are constantly increasing. This may manifest as either an exacerbation of a chronic disease or the development of a new disorder, referred to as immune reconstitution inflammatory syndrome. This review focuses on the current knowledge regarding the dermatological symptoms of immune reconstitution inflammatory syndrome observed in recent years. These symptoms encompass various pathogens, neoplasms, and certain autoimmune diseases. In addition to the most common skin reactions, attention is directed towards conditions not previously described in any review, such as psoriasis.
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Affiliation(s)
- Aleksandra Górecka
- Department of Dermatology, National Medical Institute of the Ministry of the Interior and Administration, Warsaw, Poland
| | - Sławomir Majewski
- Department of Dermatology and Venereology, Medical University of Warsaw, Warsaw, Poland
| | - Elżbieta Szymańska
- Department of Dermatology, National Medical Institute of the Ministry of the Interior and Administration, Warsaw, Poland
- Department of Dermatology and Pediatric Dermatology, Centre of Postgraduate Medical Education in Warsaw, Warsaw, Poland
| | - Irena Walecka
- Department of Dermatology, National Medical Institute of the Ministry of the Interior and Administration, Warsaw, Poland
- Department of Dermatology and Pediatric Dermatology, Centre of Postgraduate Medical Education in Warsaw, Warsaw, Poland
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Pipitò L, Medaglia AA, Trizzino M, Bonura S, Gioè C, Di Carlo P, Colomba C, Cascio A. A case of syphilis associated with immune reconstitution inflammatory syndrome and review of the literature. AIDS Res Ther 2023; 20:28. [PMID: 37170352 PMCID: PMC10176857 DOI: 10.1186/s12981-023-00522-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/02/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Immune reconstitution inflammatory syndrome (IRIS) associated with syphilis has rarely been described in HIV-infected patients. Diagnosis can be challenging because it is not always possible to discern it from a recent infection or a worsening of an undiagnosed one. CASE PRESENTATION An HIV-positive 42-year-old man with a poor compliance history of antiretroviral therapy presented at our unit and complained of ocular symptoms. Ocular syphilis diagnosis was posed after initial misdiagnosing with cytomegalovirus infection, and antiretroviral therapy compliance improved after switching to a bictegravir-based regimen. Despite intravenous (IV) penicillin, we observed an initial worsening with the appearance of new skin lesions, and IRIS syphilis was suspected. In the literature, 14 cases of IRIS syphilis are described, all regarding male patients. Seven were HIV naïve to therapy, and 7 HIV-experienced with poor therapy compliance. Basal syphilis serology was negative in ten, with subsequent seroconversion after the development of IRIS. IRIS-syphilis development was observed after a median time of 28 days from ART initiation; 10 cases were considered "unmasking-IRIS" and 4 "paradoxical-IRIS". Skin and ocular involvement were the most often reported. In most cases, it was not necessary to use a systemic steroid. A good outcome was reported in 12. CONCLUSIONS Syphilis should be considered in differential diagnosis with other diseases associated with IRIS. A negative syphilis serology before beginning antiretroviral therapy could convey the impression that syphilis has been ruled out. Whereas a high index of suspicion should be maintained when symptoms suggestive of syphilis, such as ocular and skin manifestations, are noticed after therapy has begun.
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Affiliation(s)
- Luca Pipitò
- Infectious and Tropical Diseases Unit- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro", University of Palermo, Palermo, Italy
- Infectious and Tropical Disease Unit, AOU Policlinico "P. Giaccone", Via del Vespro 129, 90127, Palermo, Italy
- Palermo Fast-Track City, Casa Dei Diritti, Via Libertà 45, 90143, Palermo, Italy
| | - Alice Annalisa Medaglia
- Infectious and Tropical Disease Unit, AOU Policlinico "P. Giaccone", Via del Vespro 129, 90127, Palermo, Italy
- Palermo Fast-Track City, Casa Dei Diritti, Via Libertà 45, 90143, Palermo, Italy
| | - Marcello Trizzino
- Infectious and Tropical Disease Unit, AOU Policlinico "P. Giaccone", Via del Vespro 129, 90127, Palermo, Italy
- Palermo Fast-Track City, Casa Dei Diritti, Via Libertà 45, 90143, Palermo, Italy
| | - Silvia Bonura
- Infectious and Tropical Disease Unit, AOU Policlinico "P. Giaccone", Via del Vespro 129, 90127, Palermo, Italy
- Palermo Fast-Track City, Casa Dei Diritti, Via Libertà 45, 90143, Palermo, Italy
| | - Claudia Gioè
- Infectious and Tropical Disease Unit, AOU Policlinico "P. Giaccone", Via del Vespro 129, 90127, Palermo, Italy
- Palermo Fast-Track City, Casa Dei Diritti, Via Libertà 45, 90143, Palermo, Italy
| | - Paola Di Carlo
- Infectious and Tropical Diseases Unit- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro", University of Palermo, Palermo, Italy
- Infectious and Tropical Disease Unit, AOU Policlinico "P. Giaccone", Via del Vespro 129, 90127, Palermo, Italy
- Palermo Fast-Track City, Casa Dei Diritti, Via Libertà 45, 90143, Palermo, Italy
| | - Claudia Colomba
- Infectious and Tropical Diseases Unit- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro", University of Palermo, Palermo, Italy
- Pediatric Infectious Diseases Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, 90127, Palermo, Italy
- Palermo Fast-Track City, Casa Dei Diritti, Via Libertà 45, 90143, Palermo, Italy
| | - Antonio Cascio
- Infectious and Tropical Diseases Unit- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro", University of Palermo, Palermo, Italy.
- Infectious and Tropical Disease Unit, AOU Policlinico "P. Giaccone", Via del Vespro 129, 90127, Palermo, Italy.
- Palermo Fast-Track City, Casa Dei Diritti, Via Libertà 45, 90143, Palermo, Italy.
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