Publicação
Toxoplasmosis-associated IRIS involving the CNS: a case report with longitudinal analysis of T cell subsets
| Resumo: | 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. |
|---|---|
| Autores principais: | Silva, Rita Catarina Assunção Ribeiro |
| Outros Autores: | Nóbrega, Cláudia; Reiriz, Eugénia; Almeida, Soraia; Castro, Rui Manuel Rosário Sarmento; Neves, Margarida Correia; Horta, Ana Maria Lacerda Morgado Fernandes Carvalho Aboim |
| Assunto: | Human immunodeficiency virus Immune reconstitution inflammatory syndrome Toxoplasmosis T cell subsets Regulatory T cells |
| Ano: | 2017 |
| País: | Portugal |
| Tipo de documento: | artigo |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Universidade do Minho |
| Idioma: | inglês |
| Origem: | RepositóriUM - Universidade do Minho |
| _version_ | 1866269433216892928 |
|---|---|
| author | Silva, Rita Catarina Assunção Ribeiro |
| author2 | Nóbrega, Cláudia Reiriz, Eugénia Almeida, Soraia Castro, Rui Manuel Rosário Sarmento Neves, Margarida Correia Horta, Ana Maria Lacerda Morgado Fernandes Carvalho Aboim |
| author2_role | author author author author author author |
| author_facet | 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 |
| author_role | author |
| contributor_name_str_mv | Universidade do Minho |
| country_str | PT |
| creators_json_txt | [{\"Person.name\":\"Silva, Rita Catarina Assunção Ribeiro\"},{\"Person.name\":\"Nóbrega, Cláudia\"},{\"Person.name\":\"Reiriz, Eugénia\"},{\"Person.name\":\"Almeida, Soraia\"},{\"Person.name\":\"Castro, Rui Manuel Rosário Sarmento\"},{\"Person.name\":\"Neves, Margarida Correia\"},{\"Person.name\":\"Horta, Ana Maria Lacerda Morgado Fernandes Carvalho Aboim\"}] |
| datacite.contributors.contributor.contributorName.fl_str_mv | Universidade do Minho |
| datacite.creators.creator.creatorName.fl_str_mv | 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 |
| datacite.date.Accepted.fl_str_mv | 2017-01-01T00:00:00Z |
| datacite.date.available.fl_str_mv | 2017-12-21T16:02:20Z |
| datacite.date.embargoed.fl_str_mv | 2017-12-21T16:02:20Z |
| datacite.rights.fl_str_mv | http://purl.org/coar/access_right/c_abf2 |
| datacite.subjects.subject.fl_str_mv | Human immunodeficiency virus Immune reconstitution inflammatory syndrome Toxoplasmosis T cell subsets Regulatory T cells |
| datacite.titles.title.fl_str_mv | Toxoplasmosis-associated IRIS involving the CNS: a case report with longitudinal analysis of T cell subsets |
| dc.contributor.none.fl_str_mv | Universidade do Minho |
| dc.creator.none.fl_str_mv | 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 |
| dc.date.Accepted.fl_str_mv | 2017-01-01T00:00:00Z |
| dc.date.available.fl_str_mv | 2017-12-21T16:02:20Z |
| dc.date.embargoed.fl_str_mv | 2017-12-21T16:02:20Z |
| dc.format.none.fl_str_mv | application/pdf |
| dc.identifier.none.fl_str_mv | https://hdl.handle.net/1822/48519 |
| dc.language.none.fl_str_mv | eng |
| dc.publisher.none.fl_str_mv | BioMed Central (BMC) |
| dc.rights.none.fl_str_mv | http://purl.org/coar/access_right/c_abf2 |
| dc.subject.none.fl_str_mv | Human immunodeficiency virus Immune reconstitution inflammatory syndrome Toxoplasmosis T cell subsets Regulatory T cells |
| dc.title.fl_str_mv | Toxoplasmosis-associated IRIS involving the CNS: a case report with longitudinal analysis of T cell subsets |
| dc.type.none.fl_str_mv | http://purl.org/coar/resource_type/c_6501 |
| description | 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. |
| dirty | 0 |
| eu_rights_str_mv | openAccess |
| format | article |
| fulltext.url.fl_str_mv | https://prod-dspace.uminho.pt/bitstreams/17a43816-c93a-45ab-909e-0fde709ab9ea/download |
| id | rum_bdae99f0eb7e92f488ff02ce9282e9bf |
| identifier.url.fl_str_mv | https://hdl.handle.net/1822/48519 |
| instacron_str | repositorium |
| institution | Universidade do Minho |
| instname_str | Universidade do Minho |
| language | eng |
| network_acronym_str | rum |
| network_name_str | RepositóriUM - Universidade do Minho |
| oai_identifier_str | oai:repositorium.uminho.pt:1822/48519 |
| organization_str_mv | urn:organizationAcronym:repositorium |
| person_str_mv | 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 |
| publishDate | 2017 |
| publisher.none.fl_str_mv | BioMed Central (BMC) |
| reponame_str | RepositóriUM - Universidade do Minho |
| repository_id_str | urn:repositoryAcronym:rum |
| service_str_mv | urn:repositoryAcronym:rum |
| spelling | engBioMed Central (BMC)porBackground: 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.application/pdfporToxoplasmosis-associated IRIS involving the CNS: a case report with longitudinal analysis of T cell subsetsSilva, Rita Catarina Assunção RibeiroNóbrega, CláudiaReiriz, EugéniaAlmeida, SoraiaCastro, Rui Manuel Rosário SarmentoNeves, Margarida CorreiaHorta, Ana Maria Lacerda Morgado Fernandes Carvalho AboimHostingInstitutionOrganizationalUniversidade do Minhoe-mailmailto:repositorium@usdb.uminho.ptrepositorium@usdb.uminho.ptISSNIsPartOf1471-2334DOIIsPartOf10.1186/s12879-016-2159-x2017-12-21T16:02:20Z20172017-12-15T16:59:20Z2017-01-01T00:00:00ZHandlehttps://hdl.handle.net/1822/48519http://purl.org/coar/access_right/c_abf2open accessHuman immunodeficiency virusImmune reconstitution inflammatory syndromeToxoplasmosisT cell subsetsRegulatory T cells2022502 bytesliteraturehttp://purl.org/coar/resource_type/c_6501journal articlehttp://purl.org/coar/access_right/c_abf2application/pdffulltexthttps://prod-dspace.uminho.pt/bitstreams/17a43816-c93a-45ab-909e-0fde709ab9ea/download |
| spellingShingle | Toxoplasmosis-associated IRIS involving the CNS: a case report with longitudinal analysis of T cell subsets Silva, Rita Catarina Assunção Ribeiro Human immunodeficiency virus Immune reconstitution inflammatory syndrome Toxoplasmosis T cell subsets Regulatory T cells |
| status | SINGLETON |
| subject.fl_str_mv | Human immunodeficiency virus Immune reconstitution inflammatory syndrome Toxoplasmosis T cell subsets Regulatory T cells |
| title | Toxoplasmosis-associated IRIS involving the CNS: a case report with longitudinal analysis of T cell subsets |
| title_full | Toxoplasmosis-associated IRIS involving the CNS: a case report with longitudinal analysis of T cell subsets |
| title_fullStr | Toxoplasmosis-associated IRIS involving the CNS: a case report with longitudinal analysis of T cell subsets |
| title_full_unstemmed | Toxoplasmosis-associated IRIS involving the CNS: a case report with longitudinal analysis of T cell subsets |
| title_short | Toxoplasmosis-associated IRIS involving the CNS: a case report with longitudinal analysis of T cell subsets |
| title_sort | Toxoplasmosis-associated IRIS involving the CNS: a case report with longitudinal analysis of T cell subsets |
| topic | Human immunodeficiency virus Immune reconstitution inflammatory syndrome Toxoplasmosis T cell subsets Regulatory T cells |
| topic_facet | Human immunodeficiency virus Immune reconstitution inflammatory syndrome Toxoplasmosis T cell subsets Regulatory T cells |
| url | https://hdl.handle.net/1822/48519 |
| visible | 1 |