title: A paradoxical decline: intracranial lesions in two HIV-positive patients recovering from cryptococcal meningitis.
abstract: Cryptococcal immune reconstitution inflammatory syndrome (C-IRIS) is an increasingly important manifestation among patients with HIV/AIDS, especially as the use of antiretroviral therapy (ART) is expanding worldwide. Cryptococcus and associated C-IRIS are common causes of meningitis. While intracranial lesions are common in HIV/AIDS, they are rarely due to cryptococcosis or C-IRIS. We describe two cases of paradoxical C-IRIS associated with the development of intracranial cryptococcomas in HIV/AIDS. Both patients had an initial episode of cryptococcal meningitis treated with antifungal therapy. At the time, they had initiated or modified ART with subsequent evidence of immune reconstitution. Two months later, they developed aseptic meningitis with intracranial lesions. After exhaustive work ups, both patients were diagnosed with paradoxical C-IRIS and biopsy confirmed intracranial cryptococcomas. We review the important clinical, diagnostic and therapeutic features of cryptococcomas associated with C-IRIS in HIV/AIDS.
authors.affiliation: Department of Internal Medicine, University of California San Francisco, San Francisco, California, USA.
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Pettersen
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Alabama, Birmingham, Birmingham, Alabama, USA.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Pappas
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, University of California San Francisco, San Francisco, California, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Chin-Hong
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, University of California San Francisco, San Francisco, California, USA Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA, USA.
authors.forename: Sanjiv M
authors.initials: SM
authors.lastname: Baxi
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects*; D000935:Antifungal Agents / Q000627:therapeutic use; D001706:Biopsy; D001921:Brain / Q000382:microbiology / Q000473:pathology; D003453:Cryptococcosis / Q000209:etiology; D003454:Cryptococcus; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology / Q000473:pathology; D008297:Male; D016919:Meningitis, Cryptococcal / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology / Q000473:pathology
chemical_list: D019380:Anti-HIV Agents; D000935:Antifungal Agents