Global InformationDiffuse infiltrative lymphocytosis syndrome information
| Diffuse infiltrative lymphocytosis syndrome | |
|---|---|
| Specialty | Immunology |
| Symptoms | Parotitis, cervical lymphadenopathy, dry eyes, dry mouth |
| Diagnostic method | Based on symptoms, confirmation of HIV infection (serology), confirmation of organ infiltration by CD8+ T cells (tissue biopsy), and exclusion of other autoimmune conditions |
| Differential diagnosis | Primary Sjogren's Syndrome, IgG4-related disease, chronic hepatitis C infection, chronic HTLV1 infection, chronic graft versus host disease, and immune reconstitution inflammatory syndrome |
| Treatment | Highly active antiretroviral therapy (HAART) and as-needed steroids |
Diffuse infiltrative lymphocytosis syndrome (DILS) is a rare multi-system complication of HIV believed to occur secondary to an abnormal persistence of the initial CD8+ T cell expansion that regularly occurs in an HIV infection.[1] This persistent CD8+ T cell expansion occurs in the setting of a low CD4+/CD8+ T cell ratio and ultimately invades and destroys tissues and organs resulting in the various complications of DILS.[1][2][3][4][5] DILS classically presents with bilateral salivary gland enlargement (parotitis), cervical lymphadenopathy, and sicca symptoms such as xerophthalmia (dry eyes) and xerostomia (dry mouth), but it may also involve the lungs, nervous system, kidneys, liver, digestive tract, and muscles.[1][2][3][4][5] Once suspected, current diagnostic workups include (1) confirming HIV infection, (2) confirming six or greater months of characteristic signs and symptoms, (3) confirming organ infiltration by CD8+ T cells, and (4) exclusion of other autoimmune conditions.[1][3][4] Once the diagnosis of DILS is confirmed, management includes highly active antiretroviral therapy (HAART) and as-needed steroids.[1][4][5] With proper treatment, the overall prognosis of DILS is favorable.[1][2][4]
- ^ a b c d e f Ghrenassia, Etienne; Martis, Nihal; Boyer, Julien; Burel-Vandenbos, Fanny; Mekinian, Arsène; Coppo, Paul (2015-05-01). "The diffuse infiltrative lymphocytosis syndrome (DILS). A comprehensive review". Journal of Autoimmunity. 59: 19–25. doi:10.1016/j.jaut.2015.01.010. ISSN 0896-8411. PMID 25660200.
- ^ a b c Meer S. (2019). Human immunodeficiency virus and salivary gland pathology: an update. Oral surgery, oral medicine, oral pathology and oral radiology, 128(1), 52–59. https://doi.org/10.1016/j.oooo.2019.01.001. PMID 30827854.
- ^ a b c Nizamuddin, Imran; Koulen, Peter; McArthur, Carole P. (2018-09-13). "Contribution of HIV Infection, AIDS, and Antiretroviral Therapy to Exocrine Pathogenesis in Salivary and Lacrimal Glands". International Journal of Molecular Sciences. 19 (9): 2747. doi:10.3390/ijms19092747. ISSN 1422-0067. PMC 6164028. PMID 30217034.
- ^ a b c d e Reveille, John D.; Williams, Francis M. (2006-12-01). "Rheumatologic complications of HIV infection". Best Practice & Research Clinical Rheumatology. Infection and Musculoskeletal Conditions. 20 (6): 1159–1179. doi:10.1016/j.berh.2006.08.015. ISSN 1521-6942. PMID 17127202.
- ^ a b c Walker, U. A.; Tyndall, A.; Daikeler, T. (2008-04-25). "Rheumatic conditions in human immunodeficiency virus infection". Rheumatology. 47 (7): 952–959. doi:10.1093/rheumatology/ken132. ISSN 1462-0324. PMID 18413346.