According to current evidence, human immunodeficiency virus (HIV)-infected patients who have undergone treatment with antiretroviral therapy are at greater risk of developing herpes zoster, not when they are severely immunocompromised, but, paradoxically, when their immune system is recovering. This is a manifestation of the immune reconstitution inflammatory syndrome (IRIS). Here we report on a case of IRIS, presented as herpes zoster in a HIV-infected patient after undergoing highly active antiretroviral therapy (HAART).
Antiretroviral Therapy, Highly Active ; Herpes Zoster ; HIV ; Humans ; Immune Reconstitution Inflammatory Syndrome ; Immune System ; Iris

Tuberculosis is one of the most common opportunistic diseases in human immunodeficiency virus (HIV)-infected patients in Korea, and extra-pulmonary infections are frequent in these patients. Cutaneous miliary tuberculosis is a rare form of tuberculosis that presents as a papulopustular eruption and hematogenous dissemination of Mycobacterium tuberculosis to multiple organs. This has been reported in patients with progressive HIV infection. We report the first case of cutaneous miliary tuberculosis that developed as a manifestation of immune reconstitution inflammatory syndrome (IRIS) after initiating antiretroviral therapy (ART).
HIV ; HIV Infections ; Humans ; Immune Reconstitution Inflammatory Syndrome* ; Korea ; Mycobacterium tuberculosis ; Skin ; Tuberculosis ; Tuberculosis, Miliary*

Opportunistic infections (OIs) are the major cause of morbidity and mortality in HIV-infected patients. The incidences of many OIs are decreasing because of advances in HIV-related therapy. These decreases have been attributed to successful OI prophylaxis and the use of potent antiretroviral therapy (ART). ART has reduced the incidence of OIs and has extended the patients' life expectancy substantially. ART is the most effective approach to prevent OIs. However, HIV-infected patients continue to develop OIs. This occurs because many patients unaware of their HIV status until they present with an OI, and also because certain patients seek medical attention at a later stage during the course of disease. OIs also still occur after the patient has started ART, in the setting of treatment failure or immune reconstitution syndrome. Therefore, OIs will continue to cause substantial morbidity and mortality in patients with HIV infection, even among persons who are receiving ART. In this review, we focus on primary and secondary prophylaxis as well as the treatment of the most frequent OIs in HIV-infected patients.
HIV ; HIV Infections ; Humans ; Immune Reconstitution Inflammatory Syndrome ; Incidence ; Life Expectancy ; Mortality ; Opportunistic Infections* ; Treatment Failure

Immune reconstitution syndrome (IRS) in HIV-infected patients is an adverse consequence of the restoration of pathogen-specific immune responses during the initial months of highly active antiretroviral treatment(HAART). Previously subclinical infections are unmasked or pre-existing opportunistic infections clinically deteriorate as host immunopathological inflammatory responses are switched on. While the eye is the area where Cytomegalovirus(CMV)-associated IRS occurs most often in patients with AIDS, it also can present with intestinal or pulmonary involvement. We present a case report of an HIV-infected patient in whom CMV enterocolitis and jejunal perforation developed after HAART.
Antiretroviral Therapy, Highly Active ; Asymptomatic Infections ; Cytomegalovirus* ; Enterocolitis* ; Humans ; Immune Reconstitution Inflammatory Syndrome ; Opportunistic Infections

Immune reconstitution syndrome (IRS) in HIV-infected patients is an adverse consequence of the restoration of pathogen-specific immune responses during the initial months of highly active antiretroviral treatment(HAART). Previously subclinical infections are unmasked or pre-existing opportunistic infections clinically deteriorate as host immunopathological inflammatory responses are switched on. While the eye is the area where Cytomegalovirus(CMV)-associated IRS occurs most often in patients with AIDS, it also can present with intestinal or pulmonary involvement. We present a case report of an HIV-infected patient in whom CMV enterocolitis and jejunal perforation developed after HAART.
Antiretroviral Therapy, Highly Active ; Asymptomatic Infections ; Cytomegalovirus* ; Enterocolitis* ; Humans ; Immune Reconstitution Inflammatory Syndrome ; Opportunistic Infections

Highly active antiretroviral therapy (HAART), which restores specific immune responses, may paradoxically cause an inflammatory reaction known as immune reconstitution inflammatory syndrome (IRIS). We report a patient with acquired immune deficiency syndrome, who presented Molluscum contagiosum as IRIS after HAART, the first case in Korea.
Acquired Immunodeficiency Syndrome ; Antiretroviral Therapy, Highly Active ; HIV ; Humans ; Immune Reconstitution Inflammatory Syndrome ; Iris ; Korea ; Molluscum Contagiosum ; Skin ; Skin Manifestations

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe cutaneous adverse reaction involving various internal organs. Flare-ups after recovery from the initial presentation of DRESS are caused by relapse of drug-induced T-cell-mediated reactions. However, the specific underlying mechanism is unclear. Here, we report a case of a 60-year-old man with allopurinol-induced DRESS who suffered recurrent episodes of generalized rash with eosinophilia, which mimicked immune reconstitution inflammatory syndrome. Analysis of immunological profiles revealed that the percentages of T lymphocytes and regulatory T cells in the patient with DRESS were higher than those in healthy controls. In addition, there was a notable change in the subtype of monocytes in the patient with DRESS; the percentage of nonclassical monocytes increased, whereas that of classical monocytes decreased. Upon viral infection, nonclassical monocytes exhibited strong pro-inflammatory properties that skewed the immune response toward a Th2 profile, which was associated with persistent flare-ups of DRESS. Taken together, the results increase our understanding of the pathogenesis of DRESS as they suggest that expansion of nonclassical monocytes and Th2 cells drives disease pathogenesis.
Allopurinol ; Drug Hypersensitivity Syndrome ; Eosinophilia ; Exanthema ; Herpesviridae ; Humans ; Immune Reconstitution Inflammatory Syndrome ; Middle Aged ; Monocytes ; Recurrence ; T-Lymphocytes ; T-Lymphocytes, Regulatory ; Th2 Cells

Invasive aspergillosis (IA) is one of the most common life-threatening complications in immunocompromised patients. Voriconazole is currently the drug of choice for IA treatment. However, some patients with IA suffer clinical deterioration despite voriconazole therapy. Management of voriconazole-refractory IA remains challenging; no useful recommendations have yet been made. Voriconazole-refractory IA can be further categorized as disease attributable to misdiagnosis or co-infection with another mold; inadequate blood voriconazole blood; inadequate tissue drug concentrations attributable to angioinvasion; immune reconstitution inflammatory syndrome; or infection with voriconazole-resistant Aspergillus. Hence, when encountering a case of voriconazole-refractory IA, it is necessary to schedule sequential tests to decide whether medical treatment or surgical intervention is appropriate; to adjust the voriconazole dose via drug monitoring; to seek CYp2c19 polymorphisms; to monitor serum galactomannan levels; and to examine the drug susceptibility of the causative Aspergillus species.
Appointments and Schedules ; Aspergillosis* ; Aspergillus ; Coinfection ; Cytochrome P-450 CYP2C19 ; Diagnostic Errors ; Drug Monitoring ; Fungi ; Humans ; Immune Reconstitution Inflammatory Syndrome ; Immunocompromised Host ; Voriconazole

Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system due to JC virus. In acquired immunodeficiency syndrome (AIDS) patients, JC virus infects myelin-producing oligodendrocytes causing a non-inflammatory lytic reaction leading to demyelination and brain death. We herein report a case of a 56-years-old AIDS man who developed immune reconstitution inflammatory syndrome and died while undergoing highly active antiretroviral therapy. In this patient, the PML involved the brainstem, causing mental confusion followed by recurrent aspiration, adult respiratory distress syndrome, and eventually to early death.
Acquired Immunodeficiency Syndrome ; Antiretroviral Therapy, Highly Active ; Brain Death ; Brain Stem ; Central Nervous System ; Demyelinating Diseases ; Humans ; Immune Reconstitution Inflammatory Syndrome ; JC Virus ; Leukoencephalopathy, Progressive Multifocal ; Oligodendroglia ; Respiratory Distress Syndrome, Adult

In acquired immunodeficiency syndrome (AIDS) patients, immune reconstitution inflammatory syndrome (IRIS) due to Mycobacterium avium complex (MAC) infection is one of the most difficult IRIS types to manage. We report an unusual case of MAC-associated IRIS. At first the patient was diagnosed human immunodeficiency virus (HIV) infection after he was admitted with pneumocystis pneumonia. After starting antiretroviral therapy he presented unmasked IRIS with MAC infection. Next, he was hospitalized with continuous loose stools and new-onset fever. Investigation included computed tomography (CT), which showed homogeneous enhancement and enlargement of the lymph nodes (LN), elevation of ferritin (>1,650 ng/mL) and lactate dehydrogenase (306 IU/L) levels, and F- fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) scan, which showed increased FDG uptake. These findings were highly indicative of lymphoma. We performed laparoscopic biopsy of the mesenteric LN, and the biopsy culture grew MAC. So we made a diagnosis of MAC-associated. Therefore, IRIS must be considered as a possible diagnosis when AIDS patients develop new symptoms or exhibit exacerbations of existing symptoms. Furthermore the biopsies should be conducted.
Acquired Immunodeficiency Syndrome ; Biopsy ; Diagnosis ; Electrons ; Ferritins ; Fever ; HIV ; Humans* ; Immune Reconstitution Inflammatory Syndrome* ; Iris ; L-Lactate Dehydrogenase ; Lymph Nodes ; Lymphoma* ; Mycobacterium avium Complex* ; Mycobacterium avium* ; Mycobacterium* ; Pneumonia, Pneumocystis