Raised intracranial pressure complicating cryptococcal meningitis: immune reconstitution inflammatory syndrome or recurrent cryptococcal disease?
We report the case of a patient with advanced HIV disease and cryptococcal meningitis, who after an initially good clinical and mycological response to systemic anti-fungal treatment developed symptomatic raised intracranial pressure 10 days after initiation of highly active anti-retroviral therapy. We describe the subsequent clinical management and the features that suggest that this persistently raised ICP was more likely due to an immune reconstitution syndrome (IRIS) following HAART rather than relapse of cryptococcal disease or failure of anti-fungal therapy.
York
Josephine
J
Department of HIV/GUM, The Guy's, King's and St Thomas' School of Medicine, Weston Education Centre, King's College Hospital, Denmark Hill Campus, Cutcombe Road, London SE5 9RT, UK.
Bodi
Istvan
I
Reeves
Iain
I
Riordan-Eva
Paul
P
Easterbrook
Philippa J
PJ
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000188:drug therapy; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D019468:Disease Management; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007249:Inflammation / Q000150:complications* / Q000276:immunology; D019586:Intracranial Hypertension / Q000209:etiology*; D016919:Meningitis, Cryptococcal / Q000150:complications* / Q000188:drug therapy; D012008:Recurrence; D013577:Syndrome
D000935:Antifungal Agents