title: Neuroimaging of HIV-associated cryptococcal meningitis: comparison of magnetic resonance imaging findings in patients with and without immune reconstitution.
abstract: To determine the frequency, imaging characteristics, neuroanatomical distribution and dynamics of magnetic resonance imaging findings in HIV-associated cryptococcal meningitis in immunocompromised patients we compared patients without antiretroviral therapy with patients undergoing immune reconstitution. Neuroimaging and clinical data of 21 consecutive patients presenting to a German HIV centre in a 10-year period between 2005 and 2014 were reviewed. We identified eight patients with magnetic resonance imaging findings related to cryptococcal disease: five patients without antiretroviral therapy and three patients receiving effective antiretroviral therapy resulting in immune reconstitution. The pattern of magnetic resonance imaging manifestations was different in the two groups. In patients not on antiretroviral therapy, pseudocysts (n = 3) and lacunar ischaemic lesions (n = 2) were detected. Contrast-enhancing focal leptomeningeal and/or parenchymal lesions were found in all patients under immune reconstitution (n = 3). Magnetic resonance imaging lesions suggestive of leptomeningitis or meningoencephalitis were detected in all patients with a recurrence of cryptococcal meningitis under immune reconstitution, which differs from the classical magnetic resonance imaging findings in patients without antiretroviral therapy. In antiretroviral therapy-treated patients with past medical history of cryptococcal meningitis, detection of contrast-enhancing focal meningeal and/or parenchymal lesions should prompt further investigations for a recurrence of cryptococcal meningitis under immune reconstitution.
authors.affiliation: Department of Infectious Diseases, Vivantes Auguste-Viktoria Klinikum, Berlin, Germany juri.katchanov@icloud.com.
authors.forename: Juri
authors.initials: J
authors.lastname: Katchanov
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, Vivantes Auguste-Viktoria Klinikum, Berlin, Germany.
authors.forename: Laura
authors.initials: L
authors.lastname: Jefferys
authors.affiliation: Department of Infectious Diseases, Vivantes Auguste-Viktoria Klinikum, Berlin, Germany.
authors.forename: Keikawus
authors.initials: K
authors.lastname: Arastéh
authors.affiliation: Department of Infectious Diseases, Vivantes Auguste-Viktoria Klinikum, Berlin, Germany.
authors.forename: Hartmut
authors.initials: H
authors.lastname: Stocker
authors.affiliation: Department of Neuroradiology, Campus Charité Mitte, Charité, Berlin, Germany.
authors.forename: Eberhard
authors.initials: E
authors.lastname: Siebert
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D016080:Arachnoid Cysts / Q000473:pathology; D003455:Cryptococcus neoformans / Q000302:isolation & purification*; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D005858:Germany; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D016867:Immunocompromised Host; D008279:Magnetic Resonance Imaging; D008297:Male; D016919:Meningitis, Cryptococcal / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D008875:Middle Aged; D059906:Neuroimaging
chemical_list: D019380:Anti-HIV Agents; D000935:Antifungal Agents; D015725:Fluconazole
keywords: AIDS; Cryptococcal meningitis; Cryptococcus neoformans; Europe; HIV; IRIS; MRI; immune reconstitution; location; magnetic resonance imaging; neuroimaging; opportunistic infection; radiological features; viral disease