Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2016 Sep 20:16:495.
doi: 10.1186/s12879-016-1824-4.

Immune reconstitution inflammatory syndrome associated with dermatophytoses in two HIV-1 positive patients in rural Tanzania: a case report

Herry Mapesi  1   2   3 , Adrià Ramírez  4 , Marcel Tanner  5   6 , Christoph Hatz  5   6 , Emilio Letang  7   8   9   10 ; KIULARCO Study Group
Collaborators, Affiliations
Case Reports

Immune reconstitution inflammatory syndrome associated with dermatophytoses in two HIV-1 positive patients in rural Tanzania: a case report

Herry Mapesi et al. BMC Infect Dis. .

Abstract

Background: Immune reconstitution inflammatory syndrome associated with dermatophytoses (tinea-IRIS) may cause considerable morbidity. Yet, it has been scarcely reported and is rarely considered in the differential diagnosis of HIV associated cutaneous lesions in Africa. If identified, it responds well to antifungals combined with steroids. We present two cases of suspected tinea-immune reconstitution inflammatory syndrome from a large HIV clinic in rural Tanzania.

Cases presentation: A first case was a 33 years-old female newly diagnosed HIV patient with CD4 count of 4 cells/μL (0 %), normal complete blood count, liver and renal function tests was started on co-formulated tenofovir/emtricitabine/efavirenz and prophylactic cotrimoxazole. Two weeks later she presented with exaggerated inflammatory hyperpigmented skin plaques with central desquamation, active borders and scratch lesions on the face, trunk and lower limbs. Tinea-IRIS was suspected and fluconazole (150 mg daily) and prednisolone (1 mg/Kg/day tapered down after 1 week) were given. Her symptoms subsided completely after 8 weeks of treatment, and her next CD4 counts had increased to 134 cells/μL (11 %). The second case was a 35 years-old female newly diagnosed with HIV. She had 1 CD4 cell/μL (0 %), haemoglobin 9.8 g/dl, and normal renal and liver function tests. Esophageal candidiasis and normocytic-normochromic anaemia were diagnosed. She received fluconazole, prophylactic cotrimoxazole and tenofovir/emtricitabine/efavirenz. Seven weeks later she presented with inflammatory skin plaques with elevated margins and central hyperpigmentation on the trunk, face and limbs in the frame of a good general recovery and increased CD4 counts (188 cells/μL, 6 %). Tinea-IRIS was suspected and treated with griseofulvin 500 mg daily and prednisolone 1 mg/Kg tapered down after 1 week, with total resolution of symptoms in 2 weeks.

Conclusion: The two cases had advanced immunosuppression and developed de-novo exaggerated manifestation of inflammatory lesions compatible with tinea corporis and tinea facies in temporal association with antiretroviral treatment initiation and good immunological response. This is compatible with unmasking tinea-IRIS, and reminds African clinicians about the importance of considering this entity in the differential diagnosis of patients with skin lesions developing after antiretroviral treatment initiation.

Keywords: Case report; HIV; Immune reconstitution inflammatory syndrome.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Pictures of the case I before and after treatment. Picture a shows exaggerated inflammatory manifestation, including hyperpigmented skin plaques with central desquamation and active borders. The lesions were itching in nature surrounded by scratchy lesions on the face, trunk and lower limbs. Picture b shows improvement after 8 weeks treatment with fluconazole, prednisolone and cetirizine
Fig. 2
Fig. 2
Pictures of the case II before and after treatment. Picture a shows inflammatory skin plaques with elevated margins and central hyperpigmentation on the trunk, face and limbs 7 weeks after ART initiation. Picture b shows improvement after 2 weeks treatment with griseofulvin, prednisolone and cetirizine
See this image and copyright information in PMC

References

    1. Osei-Sekyere B, Karstaedt AS. Immune reconstitution inflammatory syndrome involving the skin. Clin Exp Dermatol. 2010;35(5):477–81. doi: 10.1111/j.1365-2230.2009.03620.x. - DOI - PubMed
    1. Ansari S, Hedayati MT, Zomorodian K, Pakshir K, Badali H, Rafiei A, et al. Molecular characterization and in vitro antifungal susceptibility of 316 clinical isolates of dermatophytes in Iran. Mycopathologia. 2015;14. - PubMed
    1. Colebunders R, Mann JM, Francis H, Bila K, Izaley L, Kakonde N, et al. Generalized papular pruritic eruption in African patients with human immunodeficiency virus infection. AIDS Lond Engl. 1987;1(2):117–21. - PubMed
    1. Coldiron BM, Bergstresser PR. Prevalence and clinical spectrum of skin disease in patients infected with human immunodeficiency virus. Arch Dermatol. 1989;125(3):357–61. doi: 10.1001/archderm.1989.01670150047004. - DOI - PubMed
    1. Rodwell GEJ, Bayles CL, Towersey L, Aly R. The prevalence of dermatophyte infection in patients infected with human immunodeficiency virus. Int J Dermatol. 2008;47(4):339–43. doi: 10.1111/j.1365-4632.2008.03416.x. - DOI - PubMed

Publication types

MeSH terms