RESUMO
SUMMARY: Malignancies in human immunodeficiency virus (HIV) positive individuals have a larger role in morbidity and mortality. Appropriate clinical acumen is required for a clinician to anticipate the occurrence of lymphoma after starting antiretroviral therapy, especially in patients with CD4 <100 cells/mm3. Here is a 30-year-old man with weight loss and appetite, found to be retroviral disease positive status with low CD 4 counts. He was started on antiretroviral treatment, and following that, he developed Hodgkin's lymphoma of mixed cellularity. He is planned for an ABVD regimen and received one cycle of the same without any complications. To our knowledge, we are reporting the first case of an HIV patient with a mixed cellularity form of classical Hodgkin's lymphoma from India.
Assuntos
Infecções por HIV , Doença de Hodgkin , Humanos , Doença de Hodgkin/tratamento farmacológico , Masculino , Adulto , Infecções por HIV/tratamento farmacológico , Índia , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Contagem de Linfócito CD4 , Doxorrubicina/administração & dosagem , Doxorrubicina/efeitos adversos , Bleomicina/efeitos adversos , Bleomicina/administração & dosagem , Dacarbazina/efeitos adversos , Vimblastina/administração & dosagem , Vimblastina/efeitos adversos , Vimblastina/uso terapêutico , Antirretrovirais/uso terapêutico , Antirretrovirais/efeitos adversosRESUMO
INTRODUCTION: Infection-related glomerulonephritis (IRGN) is an immunologically mediated renal injury due to non-renal infections. With time there has been a change with respect to its incidence, etiological agents, clinical features, and outcomes. MATERIALS AND METHODS: A retrospective observational study was conducted from May 1, 2018 to May 31, 2021. OBJECTIVES: 1. To study the clinical profile of patients with renal biopsy-proven IRGN. 2. To study the outcomes of IRGN at the end of 3 months. All patients were followed up for a minimum period of 3 months. Outcomes at the end of 3 months were categorized as any one of the following: (1) normalization of renal function tests and proteinuria < 500 mg/day, (2) persistent renal dysfunction without requirement of renal replacement therapy, (3) requirement of renal replacement therapy. RESULTS: A total of 114 patients were included in the study. The incidence of IRGN was 4.6%. The majority were males and in the fifth decade of life. Focus of infection was identified in 59.6% of cases. Acute glomerulonephritis (35.1%) and nephrotic syndrome (35.1%) were the most common syndromic presentations. 68.4% of patients had complete recovery at the end of 3 months. 15.7% of patients progressed to chronic kidney disease, and 15.7% of patients required renal replacement therapy. Elderly patients' requirement of renal replacement therapy and higher creatinine at presentation were significantly associated with poor outcomes (p < 0.05). CONCLUSION: This study emphasizes the need for early identification of the source of infection and treatment with appropriate antibiotics. Strategies to identify occult sources of infection should be employed. Elderly age and requirement of renal replacement therapy were associated with poor outcomes.