Co-existence of eosinophilic granulomatosis with polyangiitis, HIV and HCV infection: A rare coincidence?

Abstract

Vasculitis is a rare manifestation of human immunodeficiency virus (HIV) or Hepatitis C infection (HCV). It is postulated that HIV can increase levels of IL4, IL5, IgE and eosinophils, with peripheral eosinophilia being usual in early stages of the disease. We present a case of a female that was admitted to Hospital das Clinicas of University of Sao Paulo Medical School at the age of 28 years (1986) l because of an abdominal wall necrosis after a caesarian section. She evolved to an acute respiratory failure and was intubated and mechanically ventilated. Thoracic CT revealed bilateral interstitial infiltrates and peripheral blood revealed eosinophilia. She was submitted to an open lung biopsy that revealed eosinophilic granulomatous vasculitis. With the diagnosis of Eosinophilic granulomatous with poliangeitis ( EGPA: former Churg-Strauss syndrome) she received i.v methylprednisolone with improvement and extubation from the ventilator. During follow up she had facial palsy, difficult to control asthma and vasculitic skin lesions controlled with prednisone . Six years after the initial diagnosis (1992) she presented an elevation of liver enzymes and investigation revealed positive HCV and HIV serology. After the initiation of antiretroviral therapy for HIV , the systemic vasculitis went into remission. In literature, there were only two cases reports of association of EGPA with HIV infection, none of them associated with HCV. It is the first report of the association of the three diseases in the same patient and the unexpected resolution of the systemic eosinophilic vasculitis after HIV treatment.