Thalidomide for Treatment of Immune Reconstitution Inflammatory Syndrome in a HIV Patient with Cutaneous Mycobacterium avium Complex Infection

Abstract

Immune reconstitution inflammatory syndrome (IRIS) is a severe clinical complication emerging during the initial months of antiretroviral therapy (ART) in HIV infected patients. Mycobacterium avium complex (MAC) associated IRIS typically develops in severely immunosuppressed individuals, who have an excellent response to ART. Cutaneous MAC infection is uncommon. The skin lesions almost invariably responded well to specific anti-mycobacterial treatment for MAC infection in IRIS patients. Here, we report a case whose cutaneous MAC lesions continue exacerbation despite with anti-mycobacterial treatment. But rapid clinical remission occurred after thalidomide adding to the antituberculosis treatment. Furthermore, immunomodulatory effect of thalidomide on cytokine levels such as decreasing of TNF-α, increasing of IL-4 and IL-6 were observed in the patient. Thalidomide may be an effective treatment for cutaneous MAC infection during IRIS. This is the first report of talihdomide treatment for cutaneous MAC infection during IRIS, and needs further mechanism and clinical trial investigation in this regard.