Immune reconstitution inflammatory syndrome associated with secondary syphilis

Abstract

Immune reconstitution inflammatory syndrome (IRIS) is a condition associated with paradoxical worsening and/or new onset of an opportunistic infection in HIV patients following the initiation of anti-retroviral therapy or switching to more potent antiretroviral therapy (ART) regimen. Although IRIS associated with many opportunistic infections (OIs) has been well reported, syphilis has very rarely been mentioned in this regard. A 52-year-old male, diagnosed with AIDS six weeks ago, presented with the disseminated non-pruritic painless skin rash. He denied any fever, cough, shortness of breath, and joint pain or swelling. The patient had no similar symptoms, genital ulcers, or any medical illness in the past. CD4 cell count and viral load were 40 cells/mm and 280,000 copies/ml, respectively, while screening tests for OIs including rapid plasma reagin test, quantiferon, cryptococcal antigen, and toxoplasma tests were negative at the time of HIV diagnosis. After three days of initiation of anti-retroviral therapy, he developed the above-mentioned skin rash. Repeat rapid plasma regain (RPR) test at this time was also negative. Punch biopsy of the skin lesion demonstrated findings suggestive of secondary syphilitic lesions, which was confirmed by immunostain. The repeat RPR, CD4 cell count, and viral load showed a titer of 1:256, 257 cells/mm, and 5000 copies/ml, respectively. His skin rashes faded away, and RPR titer trended down on treatment with benzathine penicillin without discontinuation of ART. The presence of an IRIS response does not predict overall HIV or OI treatment responses, and discontinuation of ART is not generally recommended as the benefits of treating HIV infection outweighs the risk associated with IRIS.

A case of secondary syphilis with pulmonary involvement and review of the literature

“…There have been cases of IRIS associated with secondary syphilis reported in the literature. 6,19,20 Another entity that cannot be ruled out in our case is syphilitic gumma, although there was no histological evidence. It can present as a nodule varying in size to a large tumorlike structure when the lung is involved.…”

Immune reconstitution inflammatory syndrome associated with secondary syphilis: dermatologic, neurologic and ophthalmologic compromise in an HIV patient

“…5 Cases of syphilis in the IRIS context in HIV patients are infrequent. [1][2][3][4]6,7 Most syphilitic IRIS presentations report secondary lesions such as skin rash or papules, [1][2][3][4] and in some cases, ophthalmologic compromise (uveitis, retinitis) without central nervous system (CNS) compromise. 6,7 Although the dermatologic symptoms of secondary syphilis are various (macular, nodular and pustular rashes with mucosal, scalp and adnexal involvement), concomitant presentation of more than one type of lesion is uncommon.…”

“…The presentation of syphilis as a manifestation of immune reconstitution inflammatory syndrome (IRIS) in patients with human immunodeficiency virus (HIV) infection is rare and can be associated with the varied clinical expression of unusual syphilitic manifestations. [1][2][3][4] Case report A 21-year-old man who has sex with men was diagnosed with HIV infection four months before admission, with no history of opportunistic infections or other comorbidities. He had a viral load of 96,000 copies/ml and CD4 T cell count of 91 cells/ml.…”

“…The presentation of syphilis as a manifestation of immune reconstitution inflammatory syndrome (IRIS) in patients with human immunodeficiency virus (HIV) infection is rare and can be associated with the varied clinical expression of unusual syphilitic manifestations. 1–4…”

Peran Steroid pada Pneumocystis Pneumonia Ditinjau Berdasarkan Imunopatogenesis

“…Pada pemeriksaan histopatologis memperlihatkan gambaran eksudat eosinofil aseluler yang mengisi alveoli. 8 Pneumocystis sulit didiagnosis karena gejala dan tanda yang tidak spesifik serta Pneumocystis jirovecii tidak dapat dikultur. Diagnosis ditegakkan dengan pemeriksaan mikroskopis.…”