title: Recurrent cryptococcal immune reconstitution inflammatory syndrome in an HIV-infected patient after anti-retroviral therapy: a case report.
abstract: Cryptococcal immune reconstitution inflammatory syndrome (C-IRIS) in HIV-infected patients presents as a clinical worsening or new presentation of cryptococcal disease as a result of anti-retroviral therapy mediated immune restoration. Recurrent C-IRIS is a rare condition. Recently, recurrent C-IRIS involving the central nervous system, which is thought to require prolonged or alternative immunosuppressive therapy, has been described. Here, we present an unusual case of recurrent C-IRIS, sequentially involving the central nervous system and lymph nodes, in an HIV-infected patient after anti-retroviral therapy. While corticosteroids were used to control the inflammatory cerebral cryptococcomas, lymphadenitis that developed after cessation of corticosteroids resolved without additional immunosuppressive or anti-inflammatory drugs. This case suggests the possibility of site-specific recovery of pathogen-specific immune response after anti-retroviral therapy. In this condition, each episode of C-IRIS may be treated independently, and extended corticosteroids may not always be needed.
authors.forename: Zhiliang
authors.initials: Z
authors.lastname: Hu
authors.forename: Hongxia
authors.initials: H
authors.lastname: Wei
authors.forename: Fanqing
authors.initials: F
authors.lastname: Meng
authors.forename: Chuanjun
authors.initials: C
authors.lastname: Xu
authors.forename: Cong
authors.initials: C
authors.lastname: Cheng
authors.affiliation: Department of Infectious Disease, The Second Affiliated Hospital of the Southeast University, Nanjing 210003, China. henanyyf@hotmail.com.
authors.forename: Yongfeng
authors.initials: Y
authors.lastname: Yang
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006651:Histocytochemistry; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology*; D008198:Lymph Nodes / Q000473:pathology; D008199:Lymphadenitis / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D016919:Meningitis, Cryptococcal / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology*; D009333:Neck / Q000000981:diagnostic imaging; D012008:Recurrence; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D019380:Anti-HIV Agents; D000893:Anti-Inflammatory Agents