Cryptococcal meningoencephalitis relapse after an eight-year delay: an interplay of infection and immune reconstitution. (October 2015)

• Record Type: Journal Article
• Authors: Katchanov, Juri; Blechschmidt, Cristiane; Nielsen, Kirsten; Branding, Gordian; Arastéh, Keikawus; Tintelnot, Kathrin; Meintjes, Graeme; Boulware, David R; Stocker, Hartmut
• Is Part Of: International journal of STD & AIDS. Volume 26:Number 12(2015:Dec.)
• Page Start: 912
• Page End: 914
• Publication Date: 2015-10
• Subjects: HIV -- AIDS -- opportunistic infection -- Cryptococcus neoformans -- cryptococcal meningitis -- CNS cryptococcosis -- immune restoration -- IRIS -- antiretroviral therapy; Sexually transmitted diseases -- Periodicals; AIDS (Disease) -- Periodicals; 616.951
• DOI: 10.1177/0956462414563630
• Languages: English
• ISSNs: 0956-4624

Abstract

We report a case of a symptomatic relapse of HIV-related cryptococcal meningoencephalitis eight years after the first diagnosis on the background of immune reconstitution. The findings as well as the clinical course suggests a combination of smouldering localised infection and enhanced inflammatory reaction related to immune restoration due to antiretroviral therapy. A combination of antifungal and anti-inflammatory therapy resulted in clinical and radiological improvement. Our case challenges the concept that immune reconstitution inflammatory syndrome and microbiological relapse are dichotomous entities.