Author(s):
Rocha, AP ; Milheiro Silva, T ; Francisco, T ; Neves, C ; Brites, V ; Candeias, F
Date: 2019
Persistent ID: http://hdl.handle.net/10400.17/3466
Origin: Repositório do Centro Hospitalar de Lisboa Central, EPE
Subject(s): Acquired Immunodeficiency Syndrome; Anti-Bacterial Agents; Antiretroviral Therapy, Highly Active; Diagnosis, Differential; Fatal Outcome; Humans; Immune Reconstitution Inflammatory Syndrome; Immunoglobulins; Infant; Lymphohistiocytosis, Hemophagocytic; Male; Methylprednisolone; Thrombotic Microangiopathies; HDE PED
Description
Some patients with human immunodeficiency virus (HIV) infection deteriorate shortly after starting highly active antiretroviral therapy (HAART), the so-called immunological reconstitution inflammatory syndrome (IRIS).1 Although having a spontaneous resolution in many instances, it can be fatal.1 Worse prognosis is seen in younger children, severe immunosuppression and central nervous system IRIS, or infections with specific agents, namely, Criptococcus.2 Hemophagocytic lymphohistiocytosis (HLH) has also been described in children with HIV infection, in the context of an immunological system dysregulation.3 Thrombotic microangiopathy (TMA) became rare with the introduction of HAART, being mostly associated with advanced disease.4 HIV-associated TMA has specific clinical aspects as well as a worse prognosis than idiopathic or congenital TMA.4-9 The authors present the case of a 10-month-old boy with advanced HIV infection who developed IRIS complicated with HLH and TMA during the course of his treatment.
