Cryptococcal lymphadenitis as a manifestation of immune reconstitution inflammatory syndrome in an HIV-positive patient: a case report and review of the literature.
Cryptococcus neoformans infections are typically associated with T-cell deficiencies, including acquired immunodeficiency syndrome (AIDS). Although highly active antiretroviral therapy (HAART) has strongly reduced AIDS-related opportunistic infections, the restoration and reactivation of CD4+ cells can induce an immune reconstitution inflammatory syndrome (IRIS), consisting in a deregulated inflammatory response to latent infectious pathogens and/or to their residual antigens. Cryptococcal lymphadenitis has occasionally been documented in IRIS. Here we report a case of histology- and culture-negative cryptococcal lymphadenitis associated with IRIS in an adult AIDS patient with a history of disseminated cryptococcosis, after the start of fully adherent HAART. Appropriate diagnosis was established on nested-PCR and sequence analysis of the interspacer region 2 of C. neoformans ribosomal DNA, and detection of slow-growing blastospores in enrichment cultures of fine-needle lymph node aspirate. Review of recent literature and our case findings suggest that IRIS-associated cryptococcal lymphadenitis is more likely the flare up of a latent infection rather than an immunopathological response to residual antigen of unviable cryptococci.
Putignani
L
L
Antonucci
G
G
Paglia
M G
MG
Vincenzi
L
L
Festa
A
A
De Mori
P
P
Loiacono
L
L
Visca
P
P
D017088:AIDS-Related Opportunistic Infections / Q000209:etiology*; D000328:Adult; D003453:Cryptococcosis / Q000209:etiology*; D006679:HIV Seropositivity / Q000150:complications*; D006801:Humans; D007249:Inflammation / Q000150:complications*; D008199:Lymphadenitis / Q000209:etiology*; D008297:Male; D013577:Syndrome