title: Paradoxical cryptococcal immune reconstitution inflammatory syndrome in advanced chronic kidney disease.
abstract: Cryptococcal-related immune reconstitution inflammatory syndrome (IRIS) is frequently seen in immunocompromised patients. A 45-year-old man with advanced chronic kidney disease (CKD) received intensive antifungal treatment for pulmonary cryptococcosis. Despite negative pleural effusion cultures and declining serum cryptococcal antigen titers, the patient presented with progressive pulmonary infiltration, intermittent fever, and elevated C-reactive protein. Steroids were given for suspected IRIS, and the clinical condition improved dramatically. This is the first report on paradoxical cryptococcal IRIS in a patient with advanced CKD.
authors.affiliation: Division of Nephrology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Chih-Chin
authors.initials: CC
authors.lastname: Kao
authors.forename: Vin-Cent
authors.initials: VC
authors.lastname: Wu
authors.forename: Hsin-Yun
authors.initials: HY
authors.lastname: Sun
authors.forename: Che-Hsiung
authors.initials: CH
authors.lastname: Wu
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D003453:Cryptococcosis / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D003455:Cryptococcus neoformans; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000150:complications* / Q000188:drug therapy; D008171:Lung Diseases / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications*
chemical_list: D000893:Anti-Inflammatory Agents; D000935:Antifungal Agents; D008775:Methylprednisolone