title: Late onset of cryptococcal cervical lymphadenitis following immune reconstitution inflammatory syndrome in a patient with AIDS.
abstract: A 32-year-old woman was diagnosed HIV positive with disseminated cryptococcal infection in May 2006. Her initial CD4 was 7 cells/µL and she had a right supraclavicular nodal mass, which was biopsied and shown to be consistent with cryptococcal lymphadenitis. She was treated for disseminated cryptococcal infection and was started on antiretroviral medications subsequently. Two years later, she developed a left supraclavicular mass. Her CD4 count was 320 cells/µL and HIV RNA level was undetectable. Investigations and biopsy results were consistent with a late presentation of cryptococcal immune reconstitution inflammatory syndrome (IRIS). She was treated with oral corticosteroids and her symptoms resolved completely. IRIS is a recognised complication of HIV treatment and occurs in a significant percentage of patients within the first 3 months of starting antiretroviral therapy. This case report illustrates the importance of recognising late presentations of IRIS. It is vital to differentiate true cryptococcal lymphadenitis from IRIS-induced cryptococcal lymphadenitis.
authors.affiliation: Department of GUM/HIV, Betsi Cadwaladr University Health Board, Bangor, UK.
authors.forename: Meenakshi
authors.initials: M
authors.lastname: Sethupathi
authors.affiliation: Department of Genito-Urinary and HIV Medicine, Abertawe Bro Morgannwg University Health Board, Singleton Hospital, Swansea, South Wales, UK.
authors.forename: Kathir
authors.initials: K
authors.lastname: Yoganathan
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy*; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects*; D003453:Cryptococcosis / Q000150:complications*; D005260:Female; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000139:chemically induced / Q000188:drug therapy / Q000382:microbiology*; D008199:Lymphadenitis / Q000382:microbiology*; D009333:Neck
chemical_list: D000305:Adrenal Cortex Hormones; D019380:Anti-HIV Agents