Please use this identifier to cite or link to this item: http://hdl.handle.net/1822/48519

TitleToxoplasmosis-associated IRIS involving the CNS: a case report with longitudinal analysis of T cell subsets
Author(s)Silva, Rita Catarina Assunção Ribeiro
Nóbrega, Cláudia
Reiriz, Eugénia
Almeida, Soraia
Castro, Rui Manuel Rosário Sarmento
Neves, Margarida Correia
Horta, Ana Maria Lacerda Morgado Fernandes Carvalho Aboim
KeywordsHuman immunodeficiency virus
Immune reconstitution inflammatory syndrome
Toxoplasmosis
T cell subsets
Regulatory T cells
Issue date2017
PublisherBioMed Central
JournalBMC Infectious Diseases
CitationRb-Silva, R., Nobrega, C., Reiriz, E., Almeida, S., Sarmento-Castro, R., Correia-Neves, M., & Horta, A. (2017). Toxoplasmosis-associated IRIS involving the CNS: a case report with longitudinal analysis of T cell subsets. BMC infectious diseases, 17(1), 66
Abstract(s)Background: HIV-infected patients may present an unforeseen clinical worsening after initiating antiretroviral therapy known as immune reconstitution inflammatory syndrome (IRIS). This syndrome is characterized by a heightened inflammatory response toward infectious or non-infectious triggers, and it may affect different organs. Diagnosis of IRIS involving the central nervous system (CNS-IRIS) is challenging due to heterogeneous manifestations, absence of biomarkers to identify this condition, risk of long-term sequelae and high mortality. Hence, a deeper knowledge of CNS-IRIS pathogenesis is needed. Case presentation: A 37-year-old man was diagnosed with AIDS and cerebral toxoplasmosis. Anti-toxoplasma treatment was initiated immediately, followed by active antiretroviral therapy (HAART) 1 month later. At 2 months of HAART, he presented with progressive hyposensitivity of the right lower limb associated with brain and dorsal spinal cord lesions, compatible with paradoxical toxoplasmosis-associated CNS-IRIS, a condition with very few reported cases. A stereotactic biopsy was planned but was postponed based on its inherent risks. Patient showed clinical improvement with no requirement of corticosteroid therapy. Routine laboratorial analysis was complemented with longitudinal evaluation of blood T cell subsets at 0, 1, 2, 3 and 6 months upon HAART initiation. A control group composed by 9 HIV-infected patients from the same hospital but with no IRIS was analysed for comparison. The CNS-IRIS patient showed lower percentage of memory CD4(+) T cells and higher percentage of activated CD4(+) T cells at HAART initiation. The percentage of memory CD4(+) T cells drastically increased at 1 month after HAART initiation and became higher in comparison to the control group until clinical recovery onset; the percentage of memory CD8(+) T cells was consistently lower throughout follow-up. Interestingly, the percentage of regulatory T cells (Treg) on the CNS-IRIS patient reached a minimum around 1 month before symptoms onset. Conclusion: Although both stereotactic biopsies and steroid therapy might be of use in CNS-IRIS cases and should be considered for these patients, they might be unnecessary to achieve clinical improvement as shown in this case. Immunological characterization of more CNS-IRIS cases is essential to shed some light on the pathogenesis of this condition.
TypeArticle
URIhttp://hdl.handle.net/1822/48519
DOI10.1186/s12879-016-2159-x
ISSN1471-2334
Publisher versionhttps://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-016-2159-x
Peer-Reviewedyes
AccessOpen access
Appears in Collections:ICVS - Artigos em Revistas Internacionais com Referee

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