2018 Volume 92 Issue 4 Pages 556-560
A 65-year-old man who had diabetes and pneumocystis pneumonia was diagnosed as having AIDS, with a CD4 count of 4/μL. After completing his pneumocystis pneumonia treatment, antiretroviral therapy was immediately started. However, his respiratory symptoms deteriorated. A diagnosis was difficult because findings from blood tests, imaging studies, and sputum cultures were unremarkable. Therefore, bronchoscopy was performed, revealing the presence of Aspergillus fumigatus in the lung tissues. The patient was diagnosed as having invasive pulmonary aspergillosis, and antifungal therapy was started. He showed a good response to the treatment and was discharged. The diagnosis was confirmed to be aspergillosis occurring as immune reconstitution inflammatory syndrome (IRIS), because of the timing of the symptoms and the clinical course. A low CD4 count is a risk factor for aspergillosis；hence, aspergillosis is suspected to be related to AIDS. Only two cases of aspergillosis occurring as IRIS have been reported thus far. Aspergillosis rarely occurs in AIDS patients, but when it does, it should be considered to occur as IRIS.
