Intestinal lymphangiectasia: an undescribed cause of malabsorption and incomplete immunological recovery in HIV-infected patients.

BACKGROUND: Although paradoxical virological and immunological response after HAART has been well studied, intestinal lymphangiectasia (IL) in HIV-1 infected patients has not previously described. METHODS: To describe HIV patients who developed IL. DESIGN: Clinical Case series. PATIENTS: 4 patients with HIV and IL diagnosis based on clinical, endoscopic and pathological findings. RESULTS: All four cases had prior mycobacterial infections with abdominal lymph node involvement and a very low CD4 cell count nadir. They developed intestinal lymphangiectasia despite appropriate virological suppression with HAART and repeatedly negative mycobacterial cultures. Two patients were clinically symptomatic with oedemas, ascites, diarrhoea, asthenia, weight loss; but the other two were diagnosed with malabsorption as a result of laboratory findings, with hypoproteinemia and hypoalbuminemia. Three of them were diagnosed by video capsule endoscopy. CONCLUSIONS: IL should be considered in HIV-1 infected patients who present with clinical or biochemical malabsorption parameters when there is no immunological recovery while on HAART.

Intestinal lymphangiectasia: an undescribed cause of malabsorption and incomplete immunological recovery in HIV-infected patients

Background Although paradoxical virological and immunological response after HAART has been well studied, intestinal lymphangiectasia (IL) in HIV-1 infected patients has not previously described. Methods To describe HIV patients who developed IL. Design Clinical Case series.Patients4 patients with HIV and IL diagnosis based on clinical, endoscopic and pathological findings. Results All four cases had prior mycobacterial infections with abdominal lymph node involvement and a very low CD4 cell count nadir. They developed intestinal lymphangiectasia despite appropriate virological suppression with HAART and repeatedly negative mycobacterial cultures. Two patients were clinically symptomatic with oedemas, ascites, diarrhoea, asthenia, weight loss; but the other two were diagnosed with malabsorption as a result of laboratory findings, with hypoproteinemia and hypoalbuminemia. Three of them were diagnosed by video capsule endoscopy. Conclusions IL should be considered in HIV-1 infected patients who present with clinical or biochemical malabsorption parameters when there is no immunological recovery while on HAART (AU)

Antecedentes Aunque las respuestas paradójicas al tratamiento antirretroviral, con ausencia de respuesta inmunológica a pesar de buen control virológico, han sido extensamente estudiadas, no se ha descrito hasta ahora la presencia de linfangiectasia intestinal (LI) como causa de las mismas. Método Serie de pacientes con infección VIH que desarrollaron LI. Diseño Series de casos clínicos. Pacientes Incluye 4 pacientes que desde el año 2002 han sido diagnosticados de LI en función de los datos clínicos y los hallazgos endoscópicos y patológicos. Resultados Los cuatro pacientes habían sido diagnósticados previamente de infecciones por micobacterias con afectación de ganglios abdominales y presentaron un recuento de linfocitos CD4 nadir muy bajo. Todos desarrollaron LI a pesar de mantener una supresión virológica mantenida con el tratamiento antirretroviral y cultivos frente a micobacterias repetidamente negativos. Dos pacientes desarrollaron clínica asociada con edemas, ascitis, diarrea, astenia y pérdida de peso, pero en los otros dos se llegó al diagnóstico por presentar parámetros bioquímicos de malabsorción pierde proteínas. En tres de ellos se llegó al diagnóstico mediante videocápsula-endoscópica. Conclusión La LI debe considerarse una causa más de falta de respuesta inmunológica al tratamiento antirretroviral, debiendo considerarse principalmente en pacientes con infección VIH y otras alteraciones clínicas o analíticas sugestivas de malabsorción. Enferm Infecc Microbiol Clin. 2011;29:117-20 (AU)