Foreign body granuloma: a new manifestation of immune restoration syndrome

People with human immunodeficiency virus may experience an immune restoration syndrome during the lymphocyte recovery period following effective highly active antiretroviral therapy. In this syndrome, antigens that previously were ignored by the immune system now induce an exaggerated response with obvious clinical effects. Most cases have been associated with infectious agents such as cytomegalovirus or mycobacterium avium intracellulare. However, the sudden onset of sarcoidal granulomatous reactions have also been described in this setting.

We report a 66-year-old HIV-positive man who presented with exacerbation of multiple foreign body granulomas decades after the original injuries. The presentation coincided with a significant rise in CD4 count after beginning highly active antiretroviral therapy.

We propose that this case demonstrates another manifestation of the immune restoration syndrome and postulate that an uncontrolled Th1 response is the causative mechanism.