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A Case of Invasive Pulmonary Aspergillosis with AIDS Occurring Immediately after Initiating Antiretroviral Therapy
Department of Clinical Infectious diseases, Toyama University Graduate School of Medicine and Pharmaceutical Sciences
Koyomi KAWAGO, Akitoshi UENO, Hitoshi KAWASUJI, Yuki MIYAJIMA, Kaoru MATSUMOTO, Yoshitsugu HIGASHI, Munetoshi NARUKAWA, Ippei SAKAMAKI & Yoshihiro YAMAMOTO
(Received December 4, 2017)
(Accepted April 24, 2018)
Key words: HIV, invasive aspergillosis, immune reconstitution inflammatory syndrome

A 65-year-old man who had diabetes and pneumocystis pneumonia was diagnosed as having AIDS, with a CD4 count of 4/μL. After completing his pneumocystis pneumonia treatment, antiretroviral therapy was immediately started. However, his respiratory symptoms deteriorated. A diagnosis was difficult because findings from blood tests, imaging studies, and sputum cultures were unremarkable. Therefore, bronchoscopy was performed, revealing the presence of Aspergillus fumigatus in the lung tissues. The patient was diagnosed as having invasive pulmonary aspergillosis, and antifungal therapy was started. He showed a good response to the treatment and was discharged. The diagnosis was confirmed to be aspergillosis occurring as immune reconstitution inflammatory syndrome (IRIS), because of the timing of the symptoms and the clinical course. A low CD4 count is a risk factor for aspergillosis; hence, aspergillosis is suspected to be related to AIDS. Only two cases of aspergillosis occurring as IRIS have been reported thus far. Aspergillosis rarely occurs in AIDS patients, but when it does, it should be considered to occur as IRIS.

[ Kansenshogaku Zasshi 92: 556-560, 2018 ]

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