Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.
[Focal mycobacterial lymphadenitis after starting highly active antiretroviral therapy]
Dtsch Med Wochenschr. 1999 Jan 22;124(3):45-8. Unique Identifier : AIDSLINE MED/99141958 Schwietert M; Battegay M; Medizinische Universitats-Poliklinik, Kantonsspital Basel.
Abstract:
HISTORY AND FINDINGS: A 30-year-old man with a known HIV infection for 7 years presented for treatment with antiretroviral drugs. He was known to have had herpes zoster, oral hairy leukoplakia and recurrent Candida stomatitis, but was otherwise without symptoms. INVESTIGATIONS: The CD4 lymphocyte count was 19 cells/mm3 and there were 41,000 HIV-RNA copies/ml. DIAGNOSIS, TREATMENT AND COURSE: The HIV infection was in CDC stage B3, indicating the need for combined antiretroviral treatment. A week after starting stavudine, saquinavir and ritonavir he had to be admitted because of nausea and vomiting, colicky abdominal pain, diarrhea, fever up to 39 degrees C and a rise of C-reactive protein to 207 mg/dl. Bacteriological examination of feces and biopsy of an enlarged retroperitoneal lymph node revealed atypical mycobacteria. Antituberculosis treatment was started. The CD4 cell count rose to 56/mm3 and the viral count fell to 11,000/ml. Each time after initiating a different antiviral regimen the symptoms recurred. CONCLUSIONS: This case illustrates an atypical manifestation of on opportunistic infection: during combined antiviral treatment the CD4 cell count rose and thus precipitated an heretofore subclinical mycobacterial infection with focal lymphadenitis. If, on starting antiretroviral treatment at a late HIV stage, new symptoms develop within 1-3 weeks, one should consider drug-induced side effects or the onset of an opportunistic infection that has become manifest as the result of an improved immunological state.
Keywords: JOURNAL ARTICLE hochaktiven antiretroviralen Therapie. Adult Anti-HIV Agents/ADMINISTRATION & DOSAGE/*ADVERSE EFFECTS Antitubercular Agents/THERAPEUTIC USE AIDS-Related Opportunistic Infections/DIAGNOSIS/DRUG THERAPY/ *ETIOLOGY Case Report Comparative Study Diagnosis, Differential Drug Therapy, Combination English Abstract Follow-Up Studies Human HIV Infections/DIAGNOSIS/DRUG THERAPY HIV Protease Inhibitors/ADMINISTRATION & DOSAGE/*ADVERSE EFFECTS Lymphadenitis/DIAGNOSIS/*ETIOLOGY Male Mesenteric Lymphadenitis/DIAGNOSIS/ETIOLOGY Mycobacterium avium-intracellulare Infection/DIAGNOSIS/DRUG THERAPY/*ETIOLOGY Reverse Transcriptase Inhibitors/ADMINISTRATION & DOSAGE/*ADVERSE EFFECTS Ritonavir/ADMINISTRATION & DOSAGE/*ADVERSE EFFECTS Saquinavir/ADMINISTRATION & DOSAGE/*ADVERSE EFFECTS Stavudine/ADMINISTRATION & DOSAGE/*ADVERSE EFFECTS Time Factors Tuberculosis/DIAGNOSIS/DRUG THERAPY/*ETIOLOGY 990530
A9950880
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Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.
