title: HIV Immune Recovery Inflammatory Syndrome and Central Nervous System Paracoccidioidomycosis.
abstract: The immune reconstitution inflammatory syndrome (IRIS) is a deregulated inflammatory response to invading microorganisms. It is manifested when there is an abrupt change in host immunity from an anti-inflammatory and immunosuppressive state to a pro-inflammatory state as a result of rapid depletion or removal of factors that promote immune suppression or inhibition of inflammation. The aim of this paper is to discuss and re-interpret the possibility of association of paracoccidioidomycosis (PCM) with IRIS in the central nervous system (CNS) in a case from Brazil published by Silva-Vergara ML. et al. (Mycopathologia 177:137-141, 6). An AIDS patient who was not receiving medical care developed pulmonary PCM successfully treated with itraconazole. The patient developed central nervous system PCM (NPCM) after starting the ARV therapy with recovery of immunity and control of HIV viral load, although it was not interpreted as IRIS by the authors, it fulfills the criteria for CNS IRIS. This could be the first case of NPCM associated with IRIS described. Although not frequent, IRIS must be considered in PCM patients and HIV, from endemic areas or patients that traveled to endemic areas, receiving ARV treatment and with worsening symptoms.
authors.affiliation: Universidade Federal do Paraná, Curitiba, Paraná, Brazil. sergio.ma@ufpr.br.|Faculdades Pequeno Príncipe, Curitiba, Paraná, Brazil. sergio.ma@ufpr.br.|Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Paraná, Brazil. sergio.ma@ufpr.br.|Seção de Virologia, Setor Análises Clínicas, Hospital de Clínicas - UFPR, Rua Padre Camargo, 280, Curitiba, PR, 80060-240, Brazil. sergio.ma@ufpr.br.
authors.forename: Sérgio Monteiro
authors.initials: SM
authors.lastname: de Almeida
authors.affiliation: Universidade Federal do Paraná, Curitiba, Paraná, Brazil.
authors.forename: Thiago Henrique
authors.initials: TH
authors.lastname: Roza
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001938:Brazil; D020314:Central Nervous System Fungal Infections / Q000175:diagnosis* / Q000473:pathology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000209:etiology* / Q000473:pathology; D008297:Male; D010229:Paracoccidioidomycosis / Q000175:diagnosis* / Q000473:pathology*
chemical_list: D044966:Anti-Retroviral Agents
keywords: Central nervous system; HIV; IRIS; Immune recovery inflammatory syndrome; Neuroparacoccidioidomycosis; Paracoccidioides brasiliensis; Paracoccidioidomycosis