A case of syphilis associated with immune reconstitution inflammatory syndrome and review of the literature.
HIV
IRIS
Paradoxical
Syphilis
Unmasking
Journal
AIDS research and therapy
ISSN: 1742-6405
Titre abrégé: AIDS Res Ther
Pays: England
ID NLM: 101237921
Informations de publication
Date de publication:
11 05 2023
11 05 2023
Historique:
received:
22
02
2023
accepted:
02
05
2023
medline:
15
5
2023
pubmed:
12
5
2023
entrez:
11
5
2023
Statut:
epublish
Résumé
Immune reconstitution inflammatory syndrome (IRIS) associated with syphilis has rarely been described in HIV-infected patients. Diagnosis can be challenging because it is not always possible to discern it from a recent infection or a worsening of an undiagnosed one. An HIV-positive 42-year-old man with a poor compliance history of antiretroviral therapy presented at our unit and complained of ocular symptoms. Ocular syphilis diagnosis was posed after initial misdiagnosing with cytomegalovirus infection, and antiretroviral therapy compliance improved after switching to a bictegravir-based regimen. Despite intravenous (IV) penicillin, we observed an initial worsening with the appearance of new skin lesions, and IRIS syphilis was suspected. In the literature, 14 cases of IRIS syphilis are described, all regarding male patients. Seven were HIV naïve to therapy, and 7 HIV-experienced with poor therapy compliance. Basal syphilis serology was negative in ten, with subsequent seroconversion after the development of IRIS. IRIS-syphilis development was observed after a median time of 28 days from ART initiation; 10 cases were considered "unmasking-IRIS" and 4 "paradoxical-IRIS". Skin and ocular involvement were the most often reported. In most cases, it was not necessary to use a systemic steroid. A good outcome was reported in 12. Syphilis should be considered in differential diagnosis with other diseases associated with IRIS. A negative syphilis serology before beginning antiretroviral therapy could convey the impression that syphilis has been ruled out. Whereas a high index of suspicion should be maintained when symptoms suggestive of syphilis, such as ocular and skin manifestations, are noticed after therapy has begun.
Sections du résumé
BACKGROUND
Immune reconstitution inflammatory syndrome (IRIS) associated with syphilis has rarely been described in HIV-infected patients. Diagnosis can be challenging because it is not always possible to discern it from a recent infection or a worsening of an undiagnosed one.
CASE PRESENTATION
An HIV-positive 42-year-old man with a poor compliance history of antiretroviral therapy presented at our unit and complained of ocular symptoms. Ocular syphilis diagnosis was posed after initial misdiagnosing with cytomegalovirus infection, and antiretroviral therapy compliance improved after switching to a bictegravir-based regimen. Despite intravenous (IV) penicillin, we observed an initial worsening with the appearance of new skin lesions, and IRIS syphilis was suspected. In the literature, 14 cases of IRIS syphilis are described, all regarding male patients. Seven were HIV naïve to therapy, and 7 HIV-experienced with poor therapy compliance. Basal syphilis serology was negative in ten, with subsequent seroconversion after the development of IRIS. IRIS-syphilis development was observed after a median time of 28 days from ART initiation; 10 cases were considered "unmasking-IRIS" and 4 "paradoxical-IRIS". Skin and ocular involvement were the most often reported. In most cases, it was not necessary to use a systemic steroid. A good outcome was reported in 12.
CONCLUSIONS
Syphilis should be considered in differential diagnosis with other diseases associated with IRIS. A negative syphilis serology before beginning antiretroviral therapy could convey the impression that syphilis has been ruled out. Whereas a high index of suspicion should be maintained when symptoms suggestive of syphilis, such as ocular and skin manifestations, are noticed after therapy has begun.
Identifiants
pubmed: 37170352
doi: 10.1186/s12981-023-00522-2
pii: 10.1186/s12981-023-00522-2
pmc: PMC10176857
doi:
Types de publication
Review
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
28Informations de copyright
© 2023. The Author(s).
Références
Mediterr J Hematol Infect Dis. 2015 Apr 20;7(1):e2015026
pubmed: 25960854
Sex Transm Infect. 2006 Dec;82(6):513-4
pubmed: 17151039
Enferm Infecc Microbiol Clin. 2009 Oct;27(8):487-9
pubmed: 19406524
J Neuropathol Exp Neurol. 2008 Aug;67(8):819-27
pubmed: 18648321
Sex Transm Dis. 2011 May;38(5):442-4
pubmed: 21124258
Int J STD AIDS. 2015 Sep;26(10):749-51
pubmed: 25311145
Int J STD AIDS. 2019 Apr;30(5):509-511
pubmed: 30999832
Curr Opin HIV AIDS. 2010 Nov;5(6):504-10
pubmed: 20966640
Clin Exp Ophthalmol. 2004 Oct;32(5):526-8
pubmed: 15498066
Int J STD AIDS. 2017 Mar;28(3):302-305
pubmed: 27566775
J Eur Acad Dermatol Venereol. 2017 Aug;31(8):e381-e382
pubmed: 28271555
Indian J Sex Transm Dis AIDS. 2021 Jul-Dec;42(2):156-158
pubmed: 34909622
Eur J Intern Med. 2009 Jan;20(1):9-13
pubmed: 19237085
Adv Dent Res. 2011 Apr;23(1):90-6
pubmed: 21441488
J Int Assoc Provid AIDS Care. 2013 Nov-Dec;12(6):380-3
pubmed: 23803565
Australas J Dermatol. 2018 May;59(2):148-150
pubmed: 28736907