Pulmonary cryptosporidiosis and immune reconstitution inflammatory syndrome: a case report and review

S Emtricitabine/raltegravir/tenofovir Pulmonary and gastrointestinal immune reconstitution inflammatory syndrome: case reportA 53-year-old man, who had AIDS and pulmonary and intestinal cryptosporidiosis developed pulmonary and gastrointestinal immune reconstitution inflammatory syndrome (IRIS) during antiretroviral therapy (ART) with raltegravir, emtricitabine and tenofovir.The man, with a history of AIDS presented with 4 months of watery diarrhoea and weight loss. He had not been taking ART for many years. He was admitted with profound metabolic acidosis and hypokalaemia. His CD4 count was 14 cells/mm 3 and HIV-1 viral load was 2,600,000 copies/mL. Stool studies showed Cryptosporidium oocysts. His diarrhoea and electrolyte abnormalities improved following the initiation of nitazoxanide, loperamide, octreotide and total parenteral nutrition. On hospital day 5, treatment with raltegravir, emtricitabine and tenofovir [dosages and routes not stated] were started. On hospital day 9, he developed a productive cough. Sputum microscopy showed Cryptosporidium oocysts. Treatment with nitazoxanide and ART was continued, and after a total of 28 days his symptoms had improved. He was discharged from the hospital. However, 17 days later, he was re-admitted with worsening diarrhoea and cough. At this time his CD4 count was 325 cells/mm 3 and HIV-1 viral load was 140 copies/mL. Repeat stool and sputum studies did not reveal cryptosporidiosis. Chest X-ray showed reticular opacities at both lung bases. Chest CT scan showed diffuse bilateral patchy pulmonary infiltrates. Biopsy showed inflamed bronchial and alveolar tissue.The man's empiric treatment with broad-spectrum antibiotic and antifungal therapy was stopped. His symptoms improved after 20 days, and he was discharged.Author comment: "[T]he patient's worsening pulmonary and gastrointestinal symptoms, which began during the restoration of immune function with ART, were attributed to pulmonary and gastrointestinal IRIS."

show abstract