Paradoxical immune reconstitution inflammatory syndrome associated with previous Cryptococcus neoformans infection in an HIV-positive patient requiring neurosurgical intervention.
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.
Biagetti
Carlo
C
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
Nicola
Monica
M
Borderi
Marco
M
Pavoni
Michele
M
Tampellini
Livia
L
Verucchi
Gabriella
G
Chiodo
Francesco
F
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
D000935:Antifungal Agents; D015725:Fluconazole