Paradoxical recurrent meningitis following therapy of cryptococcal meningitis: an immune reconstitution syndrome after initiation of highly active antiretroviral therapy.
We report a case of paradoxical recurrent meningitis in response to initiation of highly active antiretroviral therapy in a patient receiving maintenance fluconazole for a previous diagnosis of cryptococcal meningitis. We describe the unusual radiographic and histopathologic findings which are consistent with an immune reconstitution induced paradoxical inflammatory response to residual cryptococcal infection.
King
Mark D
MD
Emory University School of Medicine, Division of Infectious Diseases, Atlanta, GA 30303, USA. mking3@emory.edu
Perlino
Carl A
CA
Cinnamon
Jay
J
Jernigan
John A
JA
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000276:immunology*; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D008297:Male; D016919:Meningitis, Cryptococcal / Q000188:drug therapy / Q000276:immunology* / Q000473:pathology; D012008:Recurrence
D000935:Antifungal Agents; D015725:Fluconazole