title: Paradoxical immune reconstitution inflammatory syndrome associated with previous Cryptococcus neoformans infection in an HIV-positive patient requiring neurosurgical intervention.
abstract: Immune reconstitution inflammatory syndrome (IRIS) in HIV-1-infected patients is associated with an exaggerated inflammatory response against an opportunistic infection during highly active antiretroviral therapy. The only review on IRIS associated with Criptococcus neoformans reported 21 episodes including lymphadenitis, necrotizing pneumonitis, breast and cutaneous abscess, and cryptococcomas. To our knowledge this is the first report of IRIS associated with previous meningeal criptococcal infection which required neurosurgical intervention with placement of a ventriculo-peritoneal shunt to drain a CSF cyst formed by exclusion of the temporal horn of the right lateral ventricle. We demonstrate that this procedure is possible without complications such as cryptococcal dissemination into the peritoneum.
authors: Department of Digestive Apparatus Disease and Internal Medicine, Section of Infectious Diseases, "Alma Mater Studiorum", University of Bologna, S. Orsola Hospital, Bologna, Italy. biagetticarlo@libero.it
authors: Carlo
authors: C
authors: Biagetti
authors: Monica
authors: M
authors: Nicola
authors: Marco
authors: M
authors: Borderi
authors: Michele
authors: M
authors: Pavoni
authors: Livia
authors: L
authors: Tampellini
authors: Gabriella
authors: G
authors: Verucchi
authors: Francesco
authors: F
authors: Chiodo
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000134:cerebrospinal fluid / Q000188:drug therapy / Q000382:microbiology*; D000935:Antifungal Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D001921:Brain / Q000473:pathology; D003453:Cryptococcosis / Q000134:cerebrospinal fluid* / Q000188:drug therapy / Q000382:microbiology; D003455:Cryptococcus neoformans / Q000187:drug effects / Q000378:metabolism; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000139:chemically induced* / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D017287:Ventriculoperitoneal Shunt
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole