A Immune Reconstitution Inflammatory Syndrome and Shingles Associated with a Combined Paralysis of Three Oculomotor Nerves Case Report

Abstract

BACKGROUND: In countries with high prevalence of HIV/AIDS infection, particularly in black Africa,shingles is one of the main opportunistic infections during immunosuppression due to AIDS in youngpatients. If immunological weakness is important, usually when the CD 4 cell count is less than 100cells/mm 3 , the risk of inflammatory reactions in the first three months after initiating of antiretroviraltreatment (ART) is very high. This inflammatory reaction is called immune reconstitution inflammatorysyndrome (IRIS). This observation reports the first documented case of IRIS with V 1 shingles in a youngHIV patient at University Hospital of Brazzaville.CASE DETAILS: A 40 years old patient was seen for a pain of the right side of the face and a completeimmobility of the eyeball. The diagnosis of V 1 shingles with a pan uveitis, and a paralysis of III, IV andVI nerves was made. The patiants HIV status was positive and CD 4 cell count was 150 cells/mm 3 . Aftertwo months of evolution under ART with a CD 4 count of 850 cells /mm 3 , the symptomatology was quicklycomplicated by significant inflammation causing a phtisis bulbi.CONCLUSION: CD 4 cells count is an important indicator in the HIV/AIDS therapy. In some majorforms of IRIS, momentary pause of anti retroviral treatment is sometimes necessary.