Immune Reconstitution Inflammatory Syndrome Presenting as Superior Vena Cava Syndrome Secondary to Coccidioides Lymphadenopathy in an HIV-Infected Patient
A 39-year-old man living with AIDS presented with a swollen face. He was found to be HIV infected after presenting with Coccidioides pneumonia 2 years previously and was placed on daily fluconazole and then on highly active antiretroviral therapy. Computed tomography confirmed superior vena cava obstruction secondary to lymphadenopathy. Biopsy confirmed coccidioidomycosis with no evidence of malignancy. To our knowledge, this is the first description of superior vena cave syndrome secondary to coccidioidomycosis and the first description of immune reconstitution inflammatory syndrome involving Coccidioides.
Ahmann FRA reassessment of the clinical implications of the superior vena cava syndrome . J Clin Oncol. 1984;2:961-969.
2.
Kim K.-I. , Leung AN, Flint JDA, Muller NLChronic pulmonary coccidioidomycosis: computed tomographic and pathologic findings in 18 cases . Can Assoc Radiol J. 1998;49:401-407.
3.
Zisis C., Skevis K., Kefaloyannis EM, Avgoustou K., Bellenis I.Mediastinal tubercuous lymphandenitis presenting as superior vena cava syndrome . J Thorac Cardiovasc Surg. 2006;131:e11-e12.
4.
Frisch M., Biggar RJ, Engels EA, Goedert JJAssociation of cancer with AIDS-related immunosuppression in adults . JAMA. 2001;285:1736-1745.
5.
Park BJ, Louie O., Altorki N.Staging and the surgical management of lung cancer. Radiol Clin North Am. 2000;38:545-561.
6.
Shelburne SA , Hamill RJ, Rodriguez-Barradas MC, et al. Immune Reconstitution Inflammatory Syndrome: emergence of a unique syndrome during highly active antiretroviral therapy. Medicine. 2002;81:213-227.
7.
Shelburne SA , Visnegarwala F., Darcourt J., et al. Incidence and risk factors for immune reconstitution inflammatory syndrome during highly active antiretroviral therapy . AIDS. 2005 ;19:399-406.
8.
DeSimone JA, Pomerantz RJ, Babinchak TJInflammatory reactions in HIV-1-infected persons after initiation of highly active antiretroviral therapy. Ann Intern Med. 2000;133:447-454.
9.
Lawn SD, Bekker L.-G, Miller RFImmune reconstititution disease associated with mycobacterial infections in HIV-infected individuals receiving antiretrovirals. Lancet Infect Dis. 2005;5:361-373.
10.
Skiest DJ, Hester LJ, Hardy RDCryptococcal immune reconstitution inflammatory syndrome: report of four cases in three patients and review of the literature. J Infect. 2005;51:e289-e297.
11.
Sungkanuparph S., Jongwutiwes U., Kiertiburanakul S.Timing of Cryptococcal immune reconstitution inflammatory syndrome after antiretroviral therapy in patients with AIDS and cryptococcal meningitis. J Acquir Immune Defic Syndr. 2007;45:595-596.
12.
Lawn SD, Butera ST, Shinnick TMTuberculosis unleashed: the impact of human immunodeficiency virus on the host granulomatous response to. Mycobacterium tuberculosis. Microbes Infect.2002;4:635-646.
