Hypersensitivity pneumonia and HIV infection in occupational settings: a case report from northern Italy.

• DOI: 10.23750/abm.v90i3.7538
• Publication Date: 2019-09-06
• Authors: Matteo Riccò; Alessandro Vignali; Marco Pesci
• Keywords: Emtricitabine; Raltegravir; Hypersensitivity pneumonitis; Lymphocytopenia; Pneumocystis pneumonia

We describe a case of relapsing hypersensitivity pneumonitis (HP) manifesting as reconstitution inflammatory syndrome (IRIS) in HIV infected patient receiving antiretroviral therapy (HAART). The patient, who works farmer since the early 20s, was diagnosed with HP at age 23: after an initial steroid therapy, long lasting clinical regression followed. At 32, positivity diagnosed, HAART starting only 38 (initially, lamivudine 300 mg/daily + zidovudine mg b.i.d.). In following 15 years, CD4+ count remained <500 cells/µL until shifted to ritonavir 100 b.i.d fosamprenavir 700 b.i.d. A six-months increase (>600 cells/µL) undetectable viral load then Eventually, developed cough and slowly worsening dyspnoea. Laboratory exams (serum T cell lymphocyte 83%, CD8+ 45-51%; serum IgG for M faeni=78 mg/L P notatum >200 mg/L) high-resolution computer tomography (HRCT) were compatible HP. working tasks modified avoiding any contact allergens, achieving 6 months regression. Detectable (62 copies/mL) identified follow-up, emtricitabine 200 mg/tenofovir disoproxil fumarate 245 s.i.d. added HAART. Respiratory involvement newly relapsed. raltegravir 400 Within several weeks, signs symptoms resolved almost completely (peripheral oxygen saturation >95%: >600 steadily <50% CD4+/CD8+ ratio >55%).