Open AccessImmune reconstitution inflammatory syndrome: A therapeutic paradox
Author(s) -
Joan Felicita Samson,
V Suja,
K. Abdul Samad,
S. Sankar,
G K Libu
Publication year - 2012
Publication title -
indian dermatology online journal
Language(s) - English
Resource type - Journals
eISSN - 2249-5673
pISSN - 2229-5178
DOI - 10.4103/2229-5178.101822
Subject(s) - medicine , sarcoidosis , dermis , skin biopsy , eosinophilia , pathology , immune system , immune reconstitution inflammatory syndrome , dermatology , granuloma , biopsy , cutaneous sarcoidosis , epithelioid cell , antiretroviral therapy , immunology , human immunodeficiency virus (hiv) , immunohistochemistry , viral load
A 41-year-old HIV positive woman was started on highly active antiretroviral therapy when her CD(4) count was 54/cu mm. Three weeks later, she developed erythematous to skin-colored plaques over the face. Investigations revealed a moderate eosinophilia, raised ESR, elevated 24-hour urinary calcium and hyperglobulinemia. Skin biopsy of the facial plaque revealed prominent epithelioid cell granulomas in the dermis. Reticulin stain showed reticulin fibers within the granulomas. Five months later, all the facial lesions regressed with continuation of HAART, with no specific treatment for facial plaques. Repeat CD(4) count was 104/cu mm. A diagnosis of cutaneous sarcoidosis occurring as a part of immune reconstitution inflammatory syndrome was made. Although systemic sarcoidosis has been reported, the occurrence of cutaneous sarcoidosis as part of immune reconstitution inflammatory syndrome has not been elucidated conclusively.