Gutiérrez SM, Rodríguez CE, Pérez ZAI, de la Cruz VF

Language: Spanish
References: 9
Page: 1-7
PDF size: 222.12 Kb.

ABSTRACT

Immune reconstitution syndrome occurs due to increased immunocompetence in previously immunocompetent patients. The condition is frequent in patients with human immunodeficiency virus infection who have started a highly active antiretroviral therapy. In certain cases, the syndrome can lead to a paradoxical worsening of a previous infection. Cytomegalovirus is an opportunistic germ that, during an immune reconstitution syndrome, can lead to multifocal intestinal perforation and secondary peritonitis, in cases that are difficult to treat. The syndrome is more frequent in patients with CD4 lymphocyte count below 50/mm3 at the time of starting antiretroviral treatment. The objective is to communicate this situation through a clinical case presentation in order to facilitate suspicion as soon as possible, and to carry out appropriate treatment. We present the case of a patient with a recently diagnosed human immunodeficiency virus, under treatment with highly active antiretroviral therapy, who attended the emergency department with an acute abdomen secondary to perforation due to cytomegalovirus. Infection carries significant morbidity and mortality, and early diagnosis is essential and intravenous antiviral treatment should be started early, generally associated with surgical treatment.

REFERENCES

1. Shahani L, Hamill R.J. Therapeutics targeting inflammation in the immune reconstitution inflammatory syndrome. Transl. Res. 2016;167(1):88–103.

2. Faldetta KF, Kattakuzhy S, Wang HW, Sereti I, Sheikh V. Cytomegalovirus immune reconstitution inflammatory syndrome manifesting as acute appendicitis in an HIV-infected patient. BMC Infect. Dis. 2014;14(1):1.

3. Ruiz-Cruz M, Alvarado-de la Barrera C, Ablanedo-Terrazas Y, Reyes-Terán G. Proposed clinical case definition for cytomegalovirus–immune recovery retinitis. Clin. Infect. Dis. 2014;59(2):298–303.

4. Shiekh RA, Yasmeen S, Prindiville TP, Ruebner BH: Intestinal perforation and peritonitis in AIDS: Case series and review of the literature. JK - Practitioner 2004;11(4):248–56.

5. Wexner SD, Smithy WB, Trillo C, Hopkins BS, Dailey TH: Emergency colectomy for cytomegalovirus ileocolitis in patients with the acquired immune deficiency syndrome. Dis Colon Rectum. 1988;31(10):755–61.

6. Genta RM, Bleyzer I, Cate TR, Tandon AK, Yoffe B: In situ hybridization and immunohistochemical analysis of cytomegalovirus-associated ileal perforation. Gastroenterology. 1993;104(6):1822–7.

7. Michalopoulos N, Triantafillopoulou K, Beretouli E, Laskou S, Papavramidis TS, Pliakos I, et al. Small bowel perforation due to CMV enteritis infection in an HIV-positive patient. BMC Res. Notes. 2013;6(1):1.

8. Freeman HJ. Spontaneous free perforation of the small intestine in adults. World J. Gastroenterol. 2014;20(29):9990–7.

9. Söderlund C, Bratt GA, Engström L, Grützmeier S, Nilsson R, Sjunnesson M, et al. Surgical treatment of cytomegalovirus enterocolitis in severe human immunodeficiency virus infection. Report of eight cases. Dis Colon Rectum. 1994;37(1):63–72.