Development and management of systemic lupus erythematosus in an HIV-infected man with hepatitis C and B co-infection following interferon therapy: A case report

被引：14

作者：

Abbott I.J. ^{[1
]}

Chang C.C. ^{[1
]}

Skinner M.J. ^{[1
]}

Street A. ^{[3
,6
]}

Perry G. ^{[4
,6
]}

McLean C. ^{[5
,6
]}

Wright E.J. ^{[1
,6
,7
]}

Cameron P.U. ^{[1
,2
,6
]}

机构：

[1] Department of Infectious Diseases, Alfred Hospital, Melbourne

[2] Department of Immunology, Alfred Hospital, Melbourne

[3] Department of Haematology, Alfred Hospital, Melbourne

[4] Department of Nephrology, Alfred Hospital, Melbourne

[5] Department of Anatomical Pathology, Alfred Hospital, Melbourne

[6] Department of Medicine, Monash University, Melbourne

[7] Burnet Institute, Melbourne

来源：

Journal of Medical Case Reports | / 3卷 / 1期

关键词：

Human Immunodeficiency Virus; Systemic Lupus Erythematosus; Human Immunodeficiency Virus Infection; Lupus Nephritis; Tenofovir;

D O I：

10.4076/1752-1947-3-7289

中图分类号：

学科分类号：

摘要：

Introduction. The association of human immunodeficiency virus and immune dysfunction leading to development of autoimmune markers is well described, but human immunodeficiency virus infection is relatively protective for the development of systemic lupus erythematosus. In contrast, development of systemic lupus erythematosus with hepatitis C and with interferon therapy is well described in a number of case reports. We here describe the first case of systemic lupus erythematosus developing in a man infected with human immunodeficiency virus, hepatitis C and hepatitis B co-infection where the onset seems to have been temporally related to interferon therapy. Case presentation. We report the occurrence of systemic lupus erythematosus complicating interferon- therapy for hepatitis C in a 47-year-old asplenic male with haemophilia co-infected with human immunodeficiency virus and hepatitis B. He presented with a truncal rash, abdominal pains and headache and later developed grade IV lupus nephritis requiring haemodialysis, mycophenolate mofetil and steroid therapy. We were able to successfully withdraw dialysis and mycophenolate while maintaining stable renal function. Conclusion. Interferon- is critical in antiviral immunity against hepatitis C but also acts as a pathogenic mediator for systemic lupus erythematosus, a condition associated with activation of plasmacytoid dendritic cells that are depleted in human immunodeficiency virus infection. The occurrence of auto-antibodies and lupus-like features in the coinfections with hepatitis C require careful assessment. Immunosuppressant therapy for lupus risks exacerbating underlying infections in patients with concurrent human immunodeficiency virus, hepatitis B and C. © 2009 licensee BioMed Central Ltd.

引用

共 17 条

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