Focal mycobacterial lymphadenitis after starting highly active antiretroviral therapy

Deutsche medizinische Wochenschrift
M Schwietert, Manuel Battegay

Abstract

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. The CD4 lymphocyte count was 19 cells/mm3 and there were 41,000 HIV-RNA copies/ml. 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. 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 ...Continue Reading

Citations

Jan 30, 2004·AIDS Patient Care and STDs·Joseph A DesimoneRoger J Pomerantz
Apr 20, 2004·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Hans H HirschManuel Battegay
Jun 15, 2006·Expert Review of Anti-infective Therapy·Emil Lesho
Jul 29, 2004·AIDS·Martyn A FrenchShelley F Stone
Sep 24, 2002·The Journal of Immunology : Official Journal of the American Association of Immunologists·Hollie Hale-DonzeSharon M Wahl

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