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Immune reconstitution inflammatory syndrome unmasking erythema nodosum leprosum: a rare case report.

Arakkal GK, Damarla SV, Chanda GM - Indian J Dermatol (2015 Jan-Feb)

Bottom Line: Immune reconstitution inflammatory syndrome (IRIS) occurs as an acute symptomatic expression of a latent infection during the recovery of immune system in response to antiretroviral therapy in HIV patients.IRIS triggers both opportunistic and non-opportunistic infections.We report a case of IRIS in a patient with HIV, presenting as erythema nodosum leprosum (ENL), which led to unmasking of lepromatous leprosy following anti-retroviral therapy (ART).

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Venereology and Leprosy, Gandhi Medical College, Secunderabad, Andhra Pradesh, India.

ABSTRACT
Immune reconstitution inflammatory syndrome (IRIS) occurs as an acute symptomatic expression of a latent infection during the recovery of immune system in response to antiretroviral therapy in HIV patients. IRIS triggers both opportunistic and non-opportunistic infections. We report a case of IRIS in a patient with HIV, presenting as erythema nodosum leprosum (ENL), which led to unmasking of lepromatous leprosy following anti-retroviral therapy (ART).

No MeSH data available.


Related in: MedlinePlus

High power view ×40.-Vessels show acute and chronic perivascular inflammatory infiltrate
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Figure 5: High power view ×40.-Vessels show acute and chronic perivascular inflammatory infiltrate

Mentions: Hematological Examination revealed microcytic hypochromic anemia (Hb: 10 g%), and neutrophilic leukocytosis (TLC: 12,800/mm3) differential count N75L20M3E2, and raised ESR (68 mm in-first hour). VDRL was non-reactive, and HBsAg was negative. The findings of complete urine examination were normal. Blood glucose levels, renal function and liver function tests were normal. Chest X-ray and ultrasonography of abdomen were normal. HIV-1 was reactive, the viral load was 1,07,400 copies/mL and CD4 count 94 cells/cu. mm before starting ART. At the time of diagnosis of IRIS, which is 1 month after starting of ART, CD4 count was 151 cells/cu. mm. Slit skin smear examination for M. leprae revealed bacteriological index of 4 along with a morphological index of 20%. Biopsy taken from the nodule on the left hand [Figure 3] demonstrated mild hyperkeratosis in epidermis, grenz zone. Dermis shows edema with collection of macrophages [Figure 4]. Vessels showed acute and chronic perivascular inflammatory infiltrate [Figure 5] consistent with ENL.


Immune reconstitution inflammatory syndrome unmasking erythema nodosum leprosum: a rare case report.

Arakkal GK, Damarla SV, Chanda GM - Indian J Dermatol (2015 Jan-Feb)

High power view ×40.-Vessels show acute and chronic perivascular inflammatory infiltrate
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4318046&req=5

Figure 5: High power view ×40.-Vessels show acute and chronic perivascular inflammatory infiltrate
Mentions: Hematological Examination revealed microcytic hypochromic anemia (Hb: 10 g%), and neutrophilic leukocytosis (TLC: 12,800/mm3) differential count N75L20M3E2, and raised ESR (68 mm in-first hour). VDRL was non-reactive, and HBsAg was negative. The findings of complete urine examination were normal. Blood glucose levels, renal function and liver function tests were normal. Chest X-ray and ultrasonography of abdomen were normal. HIV-1 was reactive, the viral load was 1,07,400 copies/mL and CD4 count 94 cells/cu. mm before starting ART. At the time of diagnosis of IRIS, which is 1 month after starting of ART, CD4 count was 151 cells/cu. mm. Slit skin smear examination for M. leprae revealed bacteriological index of 4 along with a morphological index of 20%. Biopsy taken from the nodule on the left hand [Figure 3] demonstrated mild hyperkeratosis in epidermis, grenz zone. Dermis shows edema with collection of macrophages [Figure 4]. Vessels showed acute and chronic perivascular inflammatory infiltrate [Figure 5] consistent with ENL.

Bottom Line: Immune reconstitution inflammatory syndrome (IRIS) occurs as an acute symptomatic expression of a latent infection during the recovery of immune system in response to antiretroviral therapy in HIV patients.IRIS triggers both opportunistic and non-opportunistic infections.We report a case of IRIS in a patient with HIV, presenting as erythema nodosum leprosum (ENL), which led to unmasking of lepromatous leprosy following anti-retroviral therapy (ART).

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Venereology and Leprosy, Gandhi Medical College, Secunderabad, Andhra Pradesh, India.

ABSTRACT
Immune reconstitution inflammatory syndrome (IRIS) occurs as an acute symptomatic expression of a latent infection during the recovery of immune system in response to antiretroviral therapy in HIV patients. IRIS triggers both opportunistic and non-opportunistic infections. We report a case of IRIS in a patient with HIV, presenting as erythema nodosum leprosum (ENL), which led to unmasking of lepromatous leprosy following anti-retroviral therapy (ART).

No MeSH data available.


Related in: MedlinePlus