Síndrome de restaura？？o imune associada à histoplasmose

a 27-year-old hiv-positive male patient with disseminated cutaneous histoplasmosis was treated with both haart and amphotericin b (total accumulated dose of 0.5g). amphotericin b was later replaced with itraconazole (200mg/day). two months after therapy had been started and the cutaneous lesions had healed, the patient interrupted both treatments voluntarily and his health deteriorated. haart was then re-introduced and cd4+ cell count increased sharply at the same time as lymph node histoplasmosis was diagnosed. this paradoxical response? the relapse of histoplasmosis and concomitant increase in cd4+ cell count and undetectable viral load after resumption of haart ? suggests that this was a case of immune reconstitution inflammatory syndrome (iris)