Mycobacterial cervicofacial lymphadenitis in human immunodeficiency virus-infected individuals after antiretroviral therapy initiation.

OBJECTIVES/HYPOTHESIS: Mycobacterial infections are the leading cause of morbidity and mortality among human immunodeficiency virus (HIV)-infected individuals worldwide. Cervical lymph nodes are the most frequently affected extrapulmonary sites. Despite the substantial reduction in complications of HIV-tuberculosis coinfection, a proportion of individuals develop immune reconstitution inflammatory syndrome (IRIS), a term used for a clinical deterioration following initiation of antiretroviral therapy (ART). The objective of this study was to describe mycobacterial-associated IRIS in cervical lymph nodes of HIV-infected individuals receiving ART.

STUDY

DESIGN

Retrospective cohort study, set in a tertiary referral center in Mexico City.

METHODS

We included ART-naive subjects who had at least one follow-up ear, nose, and throat examination, and were diagnosed with lymph node mycobacterial infection before or during the first 3 months of ART initiation. Mycobacterial-associated IRIS in cervical lymph nodes was determined retrospectively through clinical case definition and medical chart review.

RESULTS

Thirty-three subjects who initiated ART were diagnosed with cervical lymph node mycobacteriosis; 24 had Mycobacterium tuberculosis infection and nine had nontuberculous disease.

CONCLUSIONS

M. tuberculosis was the most common pathogen isolated from cervical lymph nodes. The only factor associated with IRIS was infection with a nontuberculous mycobacteria. The unexpectedly high incidence of mycobacterial-associated IRIS underlines the relevance of head and neck examination before ART initiation.

LEVEL OF EVIDENCE: 4.