Der Internist

, 50:877 | Cite as

53-jähriger Patient mit Fieber und Husten

Kasuistiken
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Zusammenfassung

Wir beschreiben einen Patienten mit später HIV-Präsentation, Meningitis tuberculosa und offener Lungentuberkulose bei Miliartuberkulose unter schwerer HIV-assoziierter Immunsuppression. Im Verlauf tritt eine weitere opportunistische Infektion (Pneumocystis-jiroveci-Pneumonie) und im Rahmen der antiretroviralen Therapie ein Immunrekonstitutionssyndrom (IRIS) auf. Letzteres führt zu weiteren Organmanifestationen der Miliartuberkulose (urogenital, gastrointestinal). Mit der späten HIV-Präsentation assoziierte Probleme sind opportunistische Infektionen und das IRIS zu Beginn der antiretroviralen Therapie. Die Wahl des Behandlungszeitpunkts der HIV-Infektion bei gleichzeitiger opportunistischer Infektion ist entscheidend.

Schlüsselwörter

HIV-Infektion Tuberkulose Immunrekonstitutionssyndrom Antiretrovirale Therapie 

Medikamente

Rifater®

Rifampicin, Isoniazid, Pyrazinamid

Myambutol®

Ethambutol

Isozid®

Isoniazid

Nopil®

Trimethoprim/Sulfamethoxazol

Truvada®

Tenofovir, Emtricitabin

Stocrin®

Efavirenz

53 year-old patient with fever and cough

Abstract

We describe a patient with late HIV presentation, opportunistic infections and an immune reconstitution syndrome (IRIS) after starting a combination antiretroviral therapy (ART)occurring in this severely immunodeficient patient. In the beginning, a miliary tuberculosis was diagnoses, followed by a second opportunistic infection, i.e. pneumocystis jiroveci pneumonia. After start of ART, further organ manifestations developed, interpreted as immune reconstitution syndrome. The decision about the optimal time point for starting ART in the presence of an opportunistic infection is essential.

Keywords

HIV infection Tuberculosis Immune reconstitution syndrome Highly active antiretroviral therapy 

Notes

Interessenkonflikt

Die korrespondierende Autorin gibt an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer Medizin Verlag 2009

Authors and Affiliations

  1. 1.Klinik für Infektiologie & SpitalhygieneUniversitätsspital BaselBaselSchweiz

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