Non-traumatic perforation of the jejunum in a human immunodeficiency virus-infected patient receiving combination antiretroviral therapy: A case report
Journal
Medicine (United States)
Journal Volume
98
Journal Issue
49
Pages
e18163
Date Issued
2019
Author(s)
Abstract
Rationale:Non-traumatic bowel perforation caused by cytomegalovirus (CMV) and Mycobacterium avium complex (MAC) infections has become rare among patients with acquired immunodeficiency syndrome (AIDS) in the era of combination antiretroviral therapy (cART); however, CMV-associated and MAC-related immune reconstitution inflammatory syndrome (IRIS) has subsequently emerged owing to the wide use of integrase inhibitor-based regimens. Here we report a case of spontaneous perforation of the jejunum in a patient with human immunodeficiency virus (HIV) infection with good compliance to cART.Patient concerns:A 32-year-old HIV-infected man developed CMV disease and DMAC infection, as unmasking IRIS, 3 days after the initiation of cART. After appropriate treatment for opportunistic infections, intermittent fever with enlarged lymph nodes in the abdomen occurred as paradoxical IRIS. The patient was administered prednisolone with subsequent tapering according to his clinical condition.Diagnoses:Unexpected perforation of hollow organ during the titration of steroid dose with clinical presentations of severe abdominal pain was diagnosed by chest radiography.Interventions:He underwent surgical repair with peritoneal toileting smoothly.Outcomes:He was discharged well with a clean surgical wound on post-operative day 10.Lessons:Bowel perforation may be a life-threatening manifestation of IRIS in the era of cART. Steroids should be avoided, if possible, to decrease the risk of bowel perforation, especially in IRIS occurred after opportunistic diseases involving the gastrointestinal tract. ? 2019 the Author(s).
SDGs
Other Subjects
abacavir plus dolutegravir plus lamivudine; amikacin; clarithromycin; ethambutol; ganciclovir; imipenem; prednisolone; adult; antiretroviral therapy; Article; atypical mycobacteriosis; case report; clinical article; colonoscopy; computer assisted tomography; cytomegalovirus infection; diarrhea; disease course; drug dose titration; drug effect; fever; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; immune reconstitution inflammatory syndrome; intestine perforation; lymphadenopathy; male; opportunistic infection; priority journal; thorax radiography; AIDS related complex; atypical mycobacteriosis; complication; cytomegalovirus infection; highly active antiretroviral therapy; immune reconstitution inflammatory syndrome; intestine perforation; jejunum disease; Adult; AIDS-Related Opportunistic Infections; Antiretroviral Therapy, Highly Active; Cytomegalovirus Infections; HIV Infections; Humans; Immune Reconstitution Inflammatory Syndrome; Intestinal Perforation; Jejunal Diseases; Male; Mycobacterium avium-intracellulare Infection
Publisher
Lippincott Williams and Wilkins
Type
journal article