[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.