An HIV-positive Case of Obstructive Jaundice Caused by Immune Reconstitution Inflammatory Syndrome of Tuberculous Lymphadenitis Successfully Treated with Corticosteroids

Naoaki Watanabe; Ryota Sato; Hideaki Nagai; Hirotoshi Matsui; Akira Yamane; Masahiro Kawashima; Junko Suzuki; Hiroyuki Tashimo; Nobuharu Ohshima; Kimihiko Masuda; Atsuhisa Tamura; Shinobu Akagawa; Akira Hebisawa; Ken Ohta

doi:10.2169/internalmedicine.8713-16

CASE REPORTS

An HIV-positive Case of Obstructive Jaundice Caused by Immune Reconstitution Inflammatory Syndrome of Tuberculous Lymphadenitis Successfully Treated with Corticosteroids

Naoaki Watanabe, Ryota Sato, Hideaki Nagai, Hirotoshi Matsui, Akira Yamane, Masahiro Kawashima, Junko Suzuki, Hiroyuki Tashimo, Nobuharu Ohshima, Kimihiko Masuda, Atsuhisa Tamura, Shinobu Akagawa, Akira Hebisawa, Ken Ohta

Author information

Naoaki Watanabe
Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
Ryota Sato
Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
Hideaki Nagai
Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
Hirotoshi Matsui
Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
Akira Yamane
Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
Masahiro Kawashima
Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
Junko Suzuki
Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
Hiroyuki Tashimo
Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
Nobuharu Ohshima
Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
Kimihiko Masuda
Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
Atsuhisa Tamura
Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
Shinobu Akagawa
Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan
Akira Hebisawa
Department of Clinical Research, National Hospital Organization Tokyo National Hospital, Japan
Ken Ohta
Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan

Keywords: HIV, immune reconstitution inflammatory syndrome, obstructive jaundice, tuberculous lymphadenitis

JOURNAL OPEN ACCESS

2017 Volume 56 Issue 19 Pages 2661-2666

DOI https://doi.org/10.2169/internalmedicine.8713-16

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Abstract

A 60-year-old man was admitted to our hospital because of a persistent fever with enlargement of multiple lymph nodes in the mediastinum and around the pancreatic head. He was diagnosed with tuberculosis and human immunodeficiency virus infection. We started antiretroviral therapy three weeks after the initiation of anti-tuberculous therapy. Two weeks later, jaundice appeared with dilatation of the biliary tract due to further enlargement of the lymph nodes, which seemed to be immune reconstitution inflammatory syndrome (IRIS). The administration of corticosteroids resolved the obstructive jaundice without surgical treatment or endoscopic drainage. Obstructive jaundice caused by IRIS should first be treated with corticosteroids before invasive treatment.

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