Case Report: A Case of Severe Cryptococcal Immune Reconstitution Inflammatory Syndrome Presenting with Brain and Intradural Abscesses in an HIV Patient
| Autor: | Thomas Kalinoski, Jason Malenfant, Catherine Yim, Arthur Jeng |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty Antifungal Agents Biopsy Cryptococcus Anti-Inflammatory Agents Brain Abscess Flucytosine Brain Edema HIV Infections Meningitis Cryptococcal Cerebrospinal fluid Immune reconstitution inflammatory syndrome Cerebellar Diseases Immune Reconstitution Inflammatory Syndrome Recurrence Virology Amphotericin B medicine Humans Fluconazole Acquired Immunodeficiency Syndrome Empyema Subdural biology medicine.diagnostic_test business.industry Brain biopsy Brain Articles Middle Aged biology.organism_classification medicine.disease Magnetic Resonance Imaging Empyema Infectious Diseases Anti-Retroviral Agents Arachnoiditis Prednisone Parasitology Arachnoid business Meningitis medicine.drug |
| Zdroj: | Am J Trop Med Hyg |
| ISSN: | 1476-1645 |
| Popis: | Clinical worsening or new manifestation of cryptococcal disease following initiation of anti-retroviral therapy (ART) in an HIV patient is a hallmark of cryptococcal immune reconstitution inflammatory syndrome (C-IRIS). However, it can be difficult to distinguish IRIS from worsening or new infection. Here, we present a case of severe C-IRIS involving multiple cerebellar, spinal, and intradural abscesses and spinal arachnoiditis 7 months after ART initiation in an AIDS patient with uncertain prior ART compliance. He had multiple prior episodes of cryptococcal meningitis with complications necessitating ventriculoperitoneal shunt placement and was on suppressive fluconazole when he developed worsening brain manifestations. He received empiric anti-cryptococcal re-induction without improvement. All cerebrospinal fluid cultures remained sterile, with negative Cryptococcus PCR testing, and his condition continued to worsen prior to corticosteroid initiation. Ultimately, C-IRIS was diagnosed by brain biopsy. This case demonstrates an extreme in severity of C-IRIS and in the timeline of presentation after ART initiation. |
| Databáze: | OpenAIRE |
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