title: Cryptococcal meningoencephalitis relapse after an eight-year delay: an interplay of infection and immune reconstitution.
abstract: We report a case of a symptomatic relapse of HIV-related cryptococcal meningoencephalitis eight years after the first diagnosis on the background of immune reconstitution. The findings as well as the clinical course suggests a combination of smouldering localised infection and enhanced inflammatory reaction related to immune restoration due to antiretroviral therapy. A combination of antifungal and anti-inflammatory therapy resulted in clinical and radiological improvement. Our case challenges the concept that immune reconstitution inflammatory syndrome and microbiological relapse are dichotomous entities.
authors.affiliation: Department of Infectious Diseases and Gastroenterology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany juri.katchanov@icloud.com.
authors.forename: Juri
authors.initials: J
authors.lastname: Katchanov
authors.affiliation: Department of Pathology, Vivantes Klinikum Neukölln, Berlin, Germany.
authors.forename: Cristiane
authors.initials: C
authors.lastname: Blechschmidt
authors.affiliation: Department of Microbiology, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Nielsen
authors.affiliation: Department of Radiology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany.
authors.forename: Gordian
authors.initials: G
authors.lastname: Branding
authors.affiliation: Department of Infectious Diseases and Gastroenterology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany.
authors.forename: Keikawus
authors.initials: K
authors.lastname: Arastéh
authors.affiliation: Reference Laboratory for Cryptococcus neoformans, Robert Koch Institute, Berlin, Germany.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Tintelnot
authors.affiliation: Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, Western Cape, South Africa.
authors.forename: Graeme
authors.initials: G
authors.lastname: Meintjes
authors.affiliation: Division of Infectious Diseases & International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Boulware
authors.affiliation: Department of Infectious Diseases and Gastroenterology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany.
authors.forename: Hartmut
authors.initials: H
authors.lastname: Stocker
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D001706:Biopsy; D001921:Brain / Q000473:pathology; D003455:Cryptococcus neoformans / Q000235:genetics / Q000302:isolation & purification*; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000175:diagnosis*; D008297:Male; D055118:Medication Adherence; D016919:Meningitis, Cryptococcal / Q000175:diagnosis* / Q000188:drug therapy; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents; D000935:Antifungal Agents; D015725:Fluconazole
keywords: AIDS; CNS cryptococcosis; Cryptococcus neoformans; HIV; IRIS; antiretroviral therapy; cryptococcal meningitis; immune restoration; opportunistic infection