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Am. J. Trop. Med. Hyg., 81(4), 2009, pp. 559-564
doi:10.4269/ajtmh.2009.09-0077;
Copyright © 2009 by The American Society of Tropical Medicine and Hygiene

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CASE REPORT


Tegumentary Leishmaniasis as the Cause of Immune Reconstitution Inflammatory Syndrome in a Patient Co-infected with Human Immunodeficiency Virus and Leishmania guyanensis

Anette Chrusciak-Talhari, Rodrigo Ribeiro-Rodrigues*, Carolina Talhari, Roberto Moreira Silva, Jr, Luis Carlos de Lima Ferreira, Simone Ferreira de Castro Botileiro, Lucilaide Oliveira Santos, Reynaldo Dietze, AND Sinésio Talhari
Fundação de Medicina Tropical do Amazonas, Manaus, Amazonas, Brazil; Núcleo de Doenças Infecciosas, Universidade Federal do Espírito Santo, Vitória, Espirito Santo, Brazil

 

ABSTRACT

We report a case of immune reconstitution inflammatory syndrome (IRIS) in a 32-year-old man infected with human immunodeficiency virus and Leishmania guyanensis. Three months after initiation of highly active anti-retroviral therapy (HAART), the patient had disseminated cutaneous leishmaniasis and started anti-leishmanial therapy. The patient’s leishmaniasis manifestations during HAART ranged form an anergic response (46 CD4+ T cells/µL) to a disseminated cutaneous leishmaniasis (112 CD4+ T cells/µL). Eight weeks later (168 CD4+ T cells/µL, skin biopsy specimens showed inflammatory infiltrates with no detectable amastigotes. The patient then became comatose. Prednisone therapy (60 mg/day) was initiated with a significant improvement within 48 hours. Three months later (CD4+ T cell count = 184 cell/µL), localized, classic, cutaneous leishmaniasis developed in the patient and anti-leishmanial treatment was re-introduced. On that occasion, frequency of T regulatory cells was 1.82% of all CD4+ cells. Our data suggest a pivotal role for CD4+ T cells in the onset of IRIS and lesion ulceration and their association with a low frequency of T regulatory cells.

Received February 9, 2009. Accepted for publication July 2, 2009.

* Address correspondence to Rodrigo Ribeiro-Rodrigues, Núcleo de Doenças Infecciosas, Universidade Federal do Espírito Santo, Av. Marechal Campos, 1468, Maruípe, Vitória, Espirito Santo, Brazil. E-mail: rodrigrr{at}ndi.ufes.br

Authors’ addresses: Anette Chrusciak-Talhari, Carolina Talhari, Roberto Moreira Silva Jr, Luis Carlos de Lima Ferreira, Simone Ferreira de Castro Botileiro, Lucilaide Oliveira Santos, and Sinésio Talhari, Fundação de Medicina Tropical do Amazonas, Av Pedro Teixeira, 25, Manaus, Amazonas, 69040-000, Brazil. Rodrigo Ribeiro-Rodrigues and Reynaldo Dietze, Núcleo de Doenças Infecciosas, Universidade Federal do Espírito Santo, Av. Marechal Campos, 1468, Maruípe, Vitória, Espirito Santo, Brazil.






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Copyright © 2009 by the American Society of Tropical Medicine and Hygiene.