Immune reconstitution syndrome masquerading as ulcerative colitis in a patient with HIV - 23/08/11
Doi : 10.1016/j.gie.2008.07.007
| Commentary The immune reconstitution inflammatory syndrome (IRIS) is described in HIV-infected patients after initiation of HAART and is characterized by paradoxical clinical worsening of an underlying opportunistic infection or AIDS-defining illness. It is paradoxical that clinical deterioration occurs despite the desired effects of increased CD4 cell counts and decreased HIV viral loads, and it is believed the syndrome results from “dysregulation” of the immune system. There is no particular syndromic definition, and its clinical manifestations are diverse, depending on the infectious (eg, mycobacteria, cryptococcus, herpes simplex virus, cytomegalovirus, progressive multifocal leukoencephalopathy) or noninfectious (eg, Guillain-Barre, sarcoid, AIDS-related lymphoma) agent involved. IRIS is more common in young men with low CD4 counts and in those with certain underlying infections (eg, mycobacteria or cryptococcus). Ulcerative colitis of new onset is distinctly unusual in a patient with AIDS, but I will remember to think of IRIS the next time a patient such as this one presents with tenesmus and hematochezia. As for the Blastocystis, a eukaryote related to the organism that caused the Irish potato famine, it is not likely the cause of IRIS. Indeed, it is arguable whether Blastocystis ever causes any significant GI symptoms; certainly not hematochezia and ulcerations. The only thing Blastocystis caused here was confusion, and as Mason Cooley, the American aphorist said, “in the theater of confusion, knowing the location of the exits is what counts.” Lawrence J. Brandt, MD Associate Editor for Focal Points |
© 2008
American Society for Gastrointestinal Endoscopy. Publié par Elsevier Masson SAS. Tous droits réservés.
Vol 68 - N° 6
P. 1197-1198 - décembre 2008 Retour au numéro
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