Immune reconstitution inflammatory syndrome in a patient with cryptococcal lymphadenitis as the first presentation of acquired immunodeficiency syndrome

Abstract Background Cytomegalovirus (CMV) retinitis is a common opportunistic infection in patients with acquired immunodeficiency syndrome. The common funduscopic manifestations are haemorrhagic necrotising variety and granular variety. Frosted branch angiitis (FBA), as a special form, when it occurred after antiretroviral therapy(ART), could possibly be associated with immune reconstitution. We report a case of FBA secondary to CMV infection-associated unmasking immune reconstitution inflammatory syndrome (IRIS). Case presentation A 27-year-old man with human immunodeficiency virus infection developed FBA after 35 days of ART. The left Aqueous humour (AqH) tested positive for CMV DNA, and the patient was diagnosed with CMV retinitis. The degree of intraocular inflammation was reflected by increased levels of interleukin (IL)-6 and IL-8 in AqH. After anti-CMV treatment and continuous ART for several months, his FBA and vision significantly improved. CMV DNA became undetectable in the left AqH, and the IL-6 and IL-8 levels in AqH decreased. Conclusion FBA could be a sign of CMV-associated unmasking IRIS. Anti-CMV treatment alone or combination with steroid treatment may be administered, depending on the changes in CMV DNA load and immunologic profile of AqH.

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Regulation of Gut Microbiota on Immune Reconstitution in Patients With Acquired Immunodeficiency Syndrome

Frontiers in Microbiology ◽

10.3389/fmicb.2020.594820 ◽

2020 ◽

Vol 11 ◽

Author(s):

Shi-Tao Geng ◽

Zun-Yue Zhang ◽

Yue-Xin Wang ◽

Danfeng Lu ◽

Juehua Yu ◽

...

Keyword(s):

Gut Microbiota ◽

Acquired Immunodeficiency Syndrome ◽

Immune Reconstitution ◽

Acquired Immunodeficiency ◽

Immunodeficiency Syndrome

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Paradoxical central nervous system immune reconstitution syndrome in acquired immunodeficiency syndrome-related primary central nervous system lymphoma

Haematologica ◽

10.3324/haematol.2014.114736 ◽

2014 ◽

Vol 100 (1) ◽

pp. e21-e24 ◽

Cited By ~ 3

Author(s):

S. M. Kranick ◽

P. H. Goncalves ◽

M. Stetler-Stevenson ◽

K. Aleman ◽

M. N. Polizzotto ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Acquired Immunodeficiency Syndrome ◽

Immune Reconstitution ◽

Central Nervous System Lymphoma ◽

Immune Reconstitution Syndrome ◽

Acquired Immunodeficiency ◽

Immunodeficiency Syndrome

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Partial Immune Reconstitution in a Patient with the Acquired Immunodeficiency Syndrome

New England Journal of Medicine ◽

10.1056/nejm198410253111706 ◽

1984 ◽

Vol 311 (17) ◽

pp. 1099-1103 ◽

Cited By ~ 46

Author(s):

H. Clifford Lane ◽

Henry Masur ◽

Dan L. Longo ◽

Harvey G. Klein ◽

Alain H. Rook ◽

...

Keyword(s):

Acquired Immunodeficiency Syndrome ◽

Immune Reconstitution ◽

Acquired Immunodeficiency ◽

Immunodeficiency Syndrome

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Cryptococcal Lymphadenitis in an HIV-Infected Patient: A Rare Manifestation of Immune Reconstitution Inflammatory Syndrome

Diseases ◽

10.3390/diseases6030070 ◽

2018 ◽

Vol 6 (3) ◽

pp. 70

Author(s):

Jose Gonzales Zamora ◽

Yogeeta Varadarajalu

Keyword(s):

Antiretroviral Therapy ◽

Immune Reconstitution Inflammatory Syndrome ◽

Highly Active Antiretroviral Therapy ◽

Immune Reconstitution ◽

Granulomatous Inflammation ◽

Highly Active ◽

Rare Manifestation ◽

Previously Treated ◽

Immunodeficiency Syndrome ◽

Inflammatory Syndrome

Cryptococcosis is a fungal infection that is typically associated with acquired immunodeficiency syndrome (AIDS). The advent of highly active antiretroviral therapy has decreased the frequency of this infection, but has led to the emergence of atypical cases of immune reconstitution inflammatory syndrome (IRIS). Here, we describe the case of a 40-year-old man who was diagnosed with HIV infection and cryptococcal meningitis. He was successfully treated with antifungals and then started antiretroviral therapy. The patient returned to the hospital 15 months later complaining of fever, pain, and neck swelling. A computed tomography (CT) scan revealed a conglomerate of necrotic lymph nodes in the supraclavicular region. He underwent biopsy and histology showed granulomatous inflammation with fungal elements, consistent with Cryptococcus. He tested positive for serum cryptococcal antigen. The patient was treated with liposomal amphotericin and flucytosine. After induction therapy, he was re-started on fluconazole. The final fungal cultures were negative. We attributed our patient’s clinical presentation to “paradoxical” IRIS, which was associated with his previously treated cryptococcosis. Near resolution of the supraclavicular mass was noted at the 3-month follow-up.

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