Severe non-specific immune reconstitution inflammatory syndrome (IRIS) presenting with graft-versus-host disease-like colitis

Excerpt

A 42-year-old, male, human immunodeficiency virus (HIV)-infected late-presenter was admitted to our hospital with Pneumocystis jiroveci pneumonia (Pjp). At presentation, his CD4 count was 12/μl (6 %), and the viral load was 471,000 copies/ml. In addition to Pjp treatment, highly active antiretroviral treatment (HAART) was started with tenofovir/emtricitabine and nevirapine. After recovery, he presented to the outpatient department 2 months later. At this point, his CD4 count was 56/μl (11 %), and his viral load was 540,000 copies/ml despite continuous intake of HAART. Resistance testing revealed the K65R, K103N, and Y181C mutations. HAART was changed to ritonavir-boosted darunavir and raltegravir. Three weeks later, the patient presented with a massive maculopapular rash, watery diarrhea, and subfebrile temperatures. His CD4 count was 781/μl (22 %), and the viral load was 1,660 copies/ml. An extensive search for opportunistic infections, including tuberculosis, was unsuccessful. Colonoscopy showed graft-versus-host disease-like colitis and ileitis (Fig. 1). This led to the diagnosis of a severe nonspecific immune reconstitution inflammatory syndrome (IRIS) due to the start of effective HAART. The differential diagnosis was a severe allergic reaction.

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