title: Dramatic improvement of severe cryptococcosis-induced immune reconstitution syndrome with adalimumab in a renal transplant recipient.
abstract: In solid organ transplant recipients, immune reconstitution inflammatory syndrome (IRIS) is a rare complication of cryptococcosis, which may require steroids in its most severe forms. Here, we report the case of a renal transplant recipient who developed severe cryptococcal meningitis-associated IRIS 1 week after immunosuppression reduction. High-dose steroids failed to improve the disease. Finally, a recombinant human monoclonal tumor necrosis factor-α (TNF-α) antagonist, adalimumab, was prescribed, and the patient rapidly experienced dramatic neurological improvement. No IRIS relapse occurred within 14 months following adalimumab discontinuation.
authors.affiliation: Service de Néphrologie et Transplantation Adulte, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes Sorbonne Paris Cité, RTRS Centaure, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Scemla
authors.forename: S
authors.initials: S
authors.lastname: Gerber
authors.forename: A
authors.initials: A
authors.lastname: Duquesne
authors.forename: P
authors.initials: P
authors.lastname: Parize
authors.forename: F
authors.initials: F
authors.lastname: Martinez
authors.forename: D
authors.initials: D
authors.lastname: Anglicheau
authors.forename: R
authors.initials: R
authors.lastname: Snanoudj
authors.forename: M
authors.initials: M
authors.lastname: Zuber
authors.forename: M-E
authors.initials: ME
authors.lastname: Bougnoux
authors.forename: C
authors.initials: C
authors.lastname: Legendre
authors.forename: O
authors.initials: O
authors.lastname: Lortholary
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D001921:Brain / Q000473:pathology; D003453:Cryptococcosis / Q000150:complications*; D005260:Female; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000188:drug therapy* / Q000209:etiology*; D007166:Immunosuppressive Agents; D016030:Kidney Transplantation; D008279:Magnetic Resonance Imaging; D016919:Meningitis, Cryptococcal / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D012720:Severity of Illness Index; D066027:Transplant Recipients; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000893:Anti-Inflammatory Agents; D061067:Antibodies, Monoclonal, Humanized; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab
keywords: antibiotic: antifungal, infection and infectious agents; clinical research/practice; fungal; immunosuppressant; infectious disease; kidney transplantation/nephrology; other