Recurrent cryptococcal immune reconstitution inflammatory syndrome in an HIV-infected patient after anti-retroviral therapy: a case reportReportar como inadecuado




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Annals of Clinical Microbiology and Antimicrobials

, 12:40

First Online: 20 December 2013Received: 21 October 2013Accepted: 15 December 2013

Abstract

Cryptococcal immune reconstitution inflammatory syndrome C-IRIS in HIV-infected patients presents as a clinical worsening or new presentation of cryptococcal disease as a result of anti-retroviral therapy mediated immune restoration. Recurrent C-IRIS is a rare condition. Recently, recurrent C-IRIS involving the central nervous system, which is thought to require prolonged or alternative immunosuppressive therapy, has been described. Here, we present an unusual case of recurrent C-IRIS, sequentially involving the central nervous system and lymph nodes, in an HIV-infected patient after anti-retroviral therapy. While corticosteroids were used to control the inflammatory cerebral cryptococcomas, lymphadenitis that developed after cessation of corticosteroids resolved without additional immunosuppressive or anti-inflammatory drugs. This case suggests the possibility of site-specific recovery of pathogen-specific immune response after anti-retroviral therapy. In this condition, each episode of C-IRIS may be treated independently, and extended corticosteroids may not always be needed.

KeywordsCryptococcal Recurrent Immune reconstitution inflammatory syndrome Lymphadenitis AbbreviationsC-IRISCryptococcal immune reconstitution inflammatory syndrome

HIVHuman immunodeficiency virus

ARTAnti-retroviral therapy

CNSCentral nervous system

CSFCerebrospinal fluid

MRIMagnetic resonance imaging

AmBAmphotericin B

CRAGCryptococcal antigen

CTComputed tomography

INSHIInternational Network for the study of HIV-associated IRIS.

Electronic supplementary materialThe online version of this article doi:10.1186-1476-0711-12-40 contains supplementary material, which is available to authorized users.

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Autor: Zhiliang Hu - Hongxia Wei - Fanqing Meng - Chuanjun Xu - Cong Cheng - Yongfeng Yang

Fuente: https://link.springer.com/







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