Immunopathological characteristics of immune reconstitution inflammatory syndrome caused by Mycobacterium parascrofulaceum infection in a patient with AIDS

Pathol Res Pract. 2011 Apr 15;207(4):262-70. doi: 10.1016/j.prp.2011.01.003. Epub 2011 Mar 4.

Abstract

Immune reconstitution inflammatory syndrome (IRIS) caused by mycobacterium in patients with AIDS is often experienced in clinical practice. There is, however, a paucity of data documenting the histopathological findings and the pathogenesis. We determined the immunopathological characteristics of IRIS associated with Mycobacterium parascrofulaceum infection in an AIDS patient. A patient presented with pulmonary lymphadenitis and involvement of the pulmonary lingular segment. Portions of the involved lymph nodes and lung were excised, and the immunological properties were analyzed by immunohistochemical assays. The histological characteristics of lymph nodes showed a caseous necrosis. Histopathologically, the pulmonary lesion was composed of exudative and proliferative lesions. CD4(+), CD8(+), CD57(+), and CD25(+)/FoxP3(+) cells were observed in both types of lesions. Clusters of CD20(+) cells and GATA3(+) cells were predominantly observed in exudative lesions, while T-bet(+) cells were dominant in proliferative lesions. ROR-γ(+) cells were also observed in exudative lesions. These results indicate that the cellular immunity to mycobacteria was recovering in the lung tissue. In M. parascrofulaceum pulmonary infection, the exudative lesion had characteristics of Th2 and Th17-type immunities. In contrast, the proliferative lesion had characteristics of Th-1 type immunity. Our data provide the first evidence to reveal the status of the axis of distinctive immunity in the process of granuloma formation caused by a mycobacterium-related infection.

Publication types

  • Case Reports

MeSH terms

  • AIDS-Related Opportunistic Infections / complications*
  • AIDS-Related Opportunistic Infections / diagnosis
  • Acquired Immunodeficiency Syndrome / complications*
  • Acquired Immunodeficiency Syndrome / diagnosis
  • Adult
  • Antibodies
  • Antiretroviral Therapy, Highly Active
  • Humans
  • Immune Reconstitution Inflammatory Syndrome / diagnosis*
  • Immune Reconstitution Inflammatory Syndrome / etiology
  • Immune Reconstitution Inflammatory Syndrome / immunology
  • Immunohistochemistry
  • Lung / microbiology
  • Lung / pathology
  • Lymph Nodes / microbiology
  • Lymph Nodes / pathology
  • Lymphatic Diseases / microbiology
  • Lymphatic Diseases / pathology
  • Male
  • Mycobacterium Infections, Nontuberculous / complications*
  • Mycobacterium Infections, Nontuberculous / diagnosis
  • Nontuberculous Mycobacteria / pathogenicity*
  • Respiratory Tract Infections / complications
  • Respiratory Tract Infections / diagnosis
  • Tomography, X-Ray Computed

Substances

  • Antibodies