title: Immune reconstitution inflammatory syndrome mimicking relapsing cryptococcal meningitis in a renal transplant recipient.
abstract: Immune reconstitution inflammatory syndrome (IRIS) is a rare entity that has been described recently in solid organ transplant (SOT) recipients. IRIS is characterized by an exuberant and dysregulated immune response following treatment of opportunistic infections. We describe here the case of a kidney transplant recipient who developed cryptococcal meningitis that was efficiently treated with antifungal therapy and decreased immunosuppression regimen. Eight months later, a paradoxical worsening of neurological symptoms and neuroradiological findings led to the diagnosis of IRIS. A short course of high-dose steroid therapy allowed complete resolution of neurological symptoms. This report highlights the challenge for physicians to distinguish IRIS from a relapsing cryptococcal infection. Clinical improvement of cryptococcosis-associated IRIS by anti-inflammatory drugs needs to be confirmed among SOT recipients.
authors.affiliation: Centre de Néphrologie et Transplantation Rénale, Université de la Méditerranée, Assistance Publique des Hôpitaux de Marseille, Hôpital Conception, Marseille, France. tristan.legris@ap-hm.fr
authors.forename: T
authors.initials: T
authors.lastname: Legris
authors.forename: M
authors.initials: M
authors.lastname: Massad
authors.forename: R
authors.initials: R
authors.lastname: Purgus
authors.forename: H
authors.initials: H
authors.lastname: Vacher-Coponat
authors.forename: S
authors.initials: S
authors.lastname: Ranque
authors.forename: N
authors.initials: N
authors.lastname: Girard
authors.forename: Y
authors.initials: Y
authors.lastname: Berland
authors.forename: V
authors.initials: V
authors.lastname: Moal
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D016919:Meningitis, Cryptococcal / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D008875:Middle Aged; D055502:Secondary Prevention; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000935:Antifungal Agents