CNS-immune reconstitution inflammatory syndrome in the setting of HIV infection, part 2: discussion of neuro-immune reconstitution inflammatory syndrome with and without other pathogens.
While the previous review of CNS-IRIS in the HIV-infected patient on highly active antiretroviral therapy (Part 1) dealt with an overview of the biology, pathology, and neurologic presentation of this condition and a discussion of the atypical imaging findings in PML-IRIS and cryptococcal meningitis-IRIS due to the robust inflammatory response, the current review (Part 2) discusses the imaging findings in other commonly encountered organisms seen in association with CNS-IRIS, namely, VZV, CMV, HIV, Candida organisms, Mycobacterium tuberculosis, and Toxoplasma gondii. Also described is the imaging appearance of CNS-IRIS when not associated with a particular organism. Recognition of these imaging findings will give credence to the diagnosis of CNS-IRIS and will allow the clinician to institute changes in medical management, if necessary, so that immune reconstitution and improved patient outcome can occur with time.
Section of Neuroradiology, Department of Radiology, University of Miami Miller School of Medicine, Jackson Memorial Medical Center, Miami, FL 33136, USA. jpost@med.miami.edu
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D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis*; D023241:Antiretroviral Therapy, Highly Active; D002177:Candidiasis / Q000175:diagnosis; D002493:Central Nervous System Diseases / Q000276:immunology*; D020314:Central Nervous System Fungal Infections / Q000175:diagnosis; D002494:Central Nervous System Infections / Q000175:diagnosis*; D020805:Central Nervous System Viral Diseases / Q000175:diagnosis; D015658:HIV Infections / Q000188:drug therapy*; D006566:Herpesviridae Infections / Q000175:diagnosis; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000175:diagnosis*; D016781:Toxoplasmosis, Cerebral / Q000175:diagnosis; D020306:Tuberculosis, Central Nervous System / Q000175:diagnosis