Mycobacterial cervicofacial lymphadenitis in human immunodeficiency virus-infected individuals after antiretroviral therapy initiation

Objectives/hypothesis: Mycobacterial infections are the leading cause of morbidity and mortality among human immunodeficiency virus (HIV)-infected individuals worldwide. Cervical lymph nodes are the most frequently affected extrapulmonary sites. Despite the substantial reduction in complications of HIV-tuberculosis coinfection, a proportion of individuals develop immune reconstitution inflammatory syndrome (IRIS), a term used for a clinical deterioration following initiation of antiretroviral therapy (ART). The objective of this study was to describe mycobacterial-associated IRIS in cervical lymph nodes of HIV-infected individuals receiving ART.

Study design: Retrospective cohort study, set in a tertiary referral center in Mexico City.

Methods: We included ART-naive subjects who had at least one follow-up ear, nose, and throat examination, and were diagnosed with lymph node mycobacterial infection before or during the first 3 months of ART initiation. Mycobacterial-associated IRIS in cervical lymph nodes was determined retrospectively through clinical case definition and medical chart review.

Results: Thirty-three subjects who initiated ART were diagnosed with cervical lymph node mycobacteriosis; 24 had Mycobacterium tuberculosis infection and nine had nontuberculous disease.

Conclusions: M. tuberculosis was the most common pathogen isolated from cervical lymph nodes. The only factor associated with IRIS was infection with a nontuberculous mycobacteria. The unexpectedly high incidence of mycobacterial-associated IRIS underlines the relevance of head and neck examination before ART initiation.

Level of evidence: 4.