Ponovljena prezentacija Gravesove bolesti kao manifestacije sindroma imune rekonstitucije u bolesnice zaražene HIV-om koja uzima antiretrovirusne lijekove

An HIV-infected patient who experienced immune reconstitution after highly active antiretroviral therapy (HAART) (increase in CD4 T-cell count from 84/mm3 to 310/mm3) presented with severe Graves’ disease twice, after commencing and recommencing HAART. At the first episode of Graves’ disease, 21 months after the introduction of HAART, the symptoms of thyroid dysfunction vanished without any specific treatment, but were associated with termination of taking HAART. At the second episode, 5 years after recommencing HAART, the patient continued taking HAART and commenced antithyroid therapy with thiamazole. Graves’ disease developed after a long period, while the patient was in good condition and when complications resulting from HAART were not expected. No features of any autoimmune disease were diagnosed before HAART initiation.Bolesnica zaražena HIV-om u koje se razvio sindrom imune rekonstitucije nakon antiretrovirusnog liječenja (ARL) (porast broja stanica CD4 s 84/mm3 na 310/mm3) prezentirala se u dva navrata s Gravesovom bolešću, na početku liječenja ARL-om i nakon stanke u liječenju. Tijekom prve epizode 21 mjesec nakon uvođenja ARL-a simptomi tiroidne disfunkcije nestali su bez specifičnog liječenja, ali su bili povezani s prestankom uzimanja ARL-a. Tijekom druge epizode 5 godina nakon ponovnog uzimanja ARL-a bolesnica je nastavila uzimati ARL i započela s antitiroidnim lijekom tiamazolom.Gravesova bolest se ponovno javila nakon dugog razdoblja kad je bolesnica bila u dobrom općem stanju i kad se komplikacije vezane uz ARL više nisu očekivale. Prije uzimanja ARL-a bolesnica nije pokazivala nikakve znakove autoimune bolesti