[HIV-therapy-associated immune reconstitution syndrome presenting as immunogenic hyperthyroidism].

HISTORY AND CLINICAL FINDINGS: A 51-year-old man infected with HIV-1 presented with weight loss, weakness, fever, agitation, tachycardia and tremor first occurring three year after initiation of antiretroviral therapy.

INVESTIGATIONS: The electrocardiogram showed atrial fibrillation. Laboratory findings revealed hyperthyroidism with fully suppressed thyroid stimulating hormone (TSH). Antibodies against thyroid globulin and TSH-receptor were markedly increased. Both alpha-fodrin antibodies and antinuclear antibodies were abnormal. Retrospective analysis revealed an association of hyperthyroidism and the presence of autoantibodies with a sudden immune reconstitution under HIV-therapy.

DIAGNOSIS, TREATMENT AND COURSE: An immune reconstitution inflammatory syndrome (IRIS) presenting as Graves's disease was diagnosed and treated with radioiodide. The patient recovered to clinical euthyroidism while antiretroviral treatment remained unchanged.

CONCLUSION: IRIS against infectious or self-antigens during HIV treatment results from local or systemic inflammatory imbalances. IRIS with autoimmune manifestations may occur even years after initiation of an effective antiretroviral therapy.