Keywords
Inmune Reconstitution Inflammatory Syndrome
Erythema multiforme
Human Inmunodeficiency Syndrome
Antiretroviral therapy
How to Cite
Abstract
The disseminated form of histoplasmosis stands as an opportunistic mycosis produced by the fungus Histoplasma capsulatum, with varied clinical manifestations and also with a widely studied relationship with the Human Immunodeficiency Virus. Patients with recent initiation of antiretroviral therapy are at greater risk of experiencing aggravation of underlying opportunistic infections or reactivation of masked infections secondary to the development of Inflammatory Immune Reconstitution Syndrome. The objective of this article is present the case of a 25-year-old patient with a history of HIV with recent initiation of antiretroviral therapy, who presents general symptoms, respiratory compromise and multiple generalized dermatological lesions, with isolation of fungal structures compatible with histoplasma in alveolar lavage and skin biopsy; thus configuring a case of disseminated histoplasmosis in the context of Inflammatory Immune Reconstitution Syndrome, with unusual skin manifestations. The importance of identifying this rare entity and its manifestations, which can be both atypical and severe, is highlighted.
References
Bekker LG, Beyrer C, Mgodi N, Lewin SR, Delany- Moretlwe S, Taiwo B, et al. HIV infection. Nat Rev Dis Primers. 2023;9(1):42.
Myint T, Anderson AM, Sanchez A, Farabi A, Hage C, Baddley JW, et al. Histoplasmosis in patients with human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/ AIDS): multicenter study of outcomes and factors associated with relapse. Medicine (Baltimore). 2014;93(1):11-18.
Batista JM, Martins MAP, Bertollo CM. Primary cutaneous histoplasmosis difficult to treat in immunocompetent patient: case report and literature review. Einstein (Sao Paulo). 2021;19:eRC5488.
Araúz AB, Papineni P. Histoplasmosis. Infect Dis Clin North Am. 2021;35(2):471-491.
Couppié P, Herceg K, Bourne-Watrin M, Thomas V, Blanchet D, Alsibai KD, et al. The Broad Clinical Spectrum of Disseminated Histoplasmosis in HIV-Infected Patients: A 30 Years’ Experience in French Guiana. J fungi (Basel, Switzerland). 2019;5(4):115.
Hidrón A, González Á. Síndrome inflamatorio de reconstitución inmune en pacientes infectados con el virus de la inmunodeficiencia humana y afecciones fúngicas. Infectio. 2012;16(3S):51-58.
Rodriguez-Hernandez A, Zavala-Trujillo IG, Arceo-Ramos M, Guzman-Rivera Z, Zavala-Cerna MG. Síndrome Inflamatorio de Reconstitución Inmune (SIRI), avances en su fisiopatogenia y consideraciones generales para el tratamiento. Open J Med. 2016;5(2):20-34.
Sharma, Surendra K, Soneja M. HIV & inmune reconstitution inflamatory syndrome (IRIS). Indian J Med Res. 2011;134(6):866-877.
Müller M, Wandel S, Colebunders R, Attia S, Furrer H, Egger M. Incidence and Lethality of Immune Reconstitution Disease in HIV-Infected Patients Starting Antiretroviral Therapy: Systematic Review and Meta-Analysis. Lancet Infect Dis. 2010;10(4):251-261.
Beishuizen SJ, Geerlings SE. Inmune reconstitution inflammatory syndrome: inmunopathogenesis, risk factors, diagnosis, treatment and prevention. Neth J Med. 2009;67(10):327-331.
French MA, Price P, Stone SF. Immune restoration disease after antiretroviral therapy. AIDS. 2004;18(12):1615-1627.
Robertson J, Meier M, Wall J, Ying J, Fichtenbaum CJ. Immune reconstitution syndrome in HIV: validating a case definition and identifying clinical predictors in persons initiating antiretroviral therapy. Clin Infect Dis. 2006;42(11):1639-1646.
Gopal R, Rapaka RR, Kolls JK. Immune reconstitution inflammatory syndrome associated with pulmonary pathogens. Eur Respir Rev. 2017;26:160042:1-8.
Peigne V, Dromer F, Elie C, Lidove O, Lortholary O,French Mycosis Study Group. Imported acquired immunodeficiency syndromerelated histoplasmosis in metropolitan France: a comparison of pre-highly active anti-retroviral therapy and highly active antiretroviral therapy eras. Am J Trop Med Hyg. 2011;85(5):934-941.
Melzani A, de Reynal de Saint Michel R, Ntab B, Djossou F, Epelboin L, Nacher M, et al. Incidence and Trends in Immune Reconstitution Inflammatory Syndrome Associated With Histoplasma capsulatum Among People Living With Human Immunodeficiency Virus: A 20-Year Case Series and Literature Review.Clin Infect Dis. 2020;70(4):643-652.
Assi MA, Sandid MS, Baddour LM, Roberts GD, Walker RC. Systemic histoplasmosis: a 15-year retrospective institutional review of 111 patients. Medicine (Baltimore). 2007;86(3):162-169.
Cunha VS, Zampese MS, Aquino VR, Cestari TF, Goldani LZ. Mucocutaneous manifestations of disseminated histoplasmosis in patients with acquired immunodeficiency syndrome: particular aspects in a Latin-American population. Clin Exp Dermatol. 2007;32(3):250-255.
Ollague Sierra JE, Ollague Torres JM. New clinical and histological patterns of acute disseminated histoplasmosis in human immunodeficiency virus-positive patients with acquired immunodeficiency syndrome. Am J Dermatopathol. 2013;35(2):205-212.
K Ramdial P, Mosam A, Dlova NC, B Satar N, Aboobaker J, Singh SM. Disseminated cutaneous histoplasmosis in patients infected with human immunodeficiency virus. J Cutan Pathol. 2002;29(4):215-225.
Astigarraga I, González-Granado LI, Allende LM, Alsina L. Síndromes hemofagocíticos: la importancia del diagnóstico y tratamiento precoces. An Pediatr (Barc). 2018;89:124.e1-8.
Reyes-Corcho A, Bouza-Jiménez Y. Síndrome de reconstitución inmunológica asociado al virus de la inmunodeficiencia humana y sida. Estado del arte. Enferm Infecc Microbiol Clin. 2010;28(2):110-121.
Dhasmana DJ, Dheda K, Ravn P, Wilkinson RJ, Meintjes G. Immune reconstitution inflammatory syndrome in HIV-infected patients receiving antiretroviral therapy: pathogenesis, clinical manifestations and management. Drugs. 2008;68(2):191-208.
Tobón AM, Agudelo CA, Rosero DS, Ochoa JE, De Bedout C, Zuluaga A, et al. Disseminated histoplasmosis: a comparative study between patients with acquired immunodeficiency syndrome and non-human immunodeficiency virus-infected individuals. Am J Trop Med Hyg. 2005;73(3):576-582.
Johnson PC, Wheat LJ, Cloud GA, Goldman M, Lancaster D, Bamberger DM, et al. Safety and efficacy of liposomal amphotericin B compared with conventional amphotericin B for induction therapy of histoplasmosis in patients with AIDS. Ann Intern Med. 2002;137(2):105-109.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2024 Médicas UIS