Challenges in diagnosis and management of Cryptococcal immune reconstitution inflammatory syndrome (IRIS) in resource limited settings

Progressive multifocal leukoencephalopathy (PML), presenting as immune reconstitution inflammatory syndrome (IRIS), is a known complication of antiretroviral therapy (ART) in people living with HIV (PLWH). Typically preceded by ART initiation, IRIS may appear simultaneously/unmasked (PML-s-IRIS) or as a delayed/worsening/paradoxical (PML-d-IRIS) presentation of known PML disease. Primary cerebellar tropism continues to be a rare presentation, and paradoxical cerebellar involvement of PML-IRIS syndrome can be a challenge for both diagnosis and management. Steroids have been suggested as a possible therapy in severe cases but the duration of steroid therapy remain elusive. Our case is that of a 34-year-old man with newly diagnosed HIV simultaneously found to have cerebellar PML. His PML lesions however worsened after initiation of ART (PML-d-IRIS) with evidence of increased intracranial pressure. Despite initial favorable response to a short duration of steroids, he had multiple recurrence of his PML lesions after steroids were discontinued. The presence of predominant cerebellar lesions and the question of how long steroids should be provided to prevent or minimize PML recurrence is the highlight of our case. This report emphasizes the need for more controlled studies to assist clinicians in the optimal diagnosis and management of PML-IRIS in PLWH.

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Strongyloidosis Hyperinfection Syndrome in an HIV-Infected Patient: A Rare Manifestation of Immune Reconstitution Inflammatory Syndrome

Case Reports in Infectious Diseases ◽

10.1155/2018/6870768 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Kartik Natrajan ◽

Mahenderkumar Medisetty ◽

Raviraj Gawali ◽

Ajit Tambolkar ◽

Divya Patel ◽

...

Keyword(s):

Immune Reconstitution Inflammatory Syndrome ◽

Immune Reconstitution ◽

Immunocompromised Host ◽

Strongyloides Stercoralis ◽

Parasitic Infections ◽

Infected Female ◽

Resource Limited ◽

Hyperinfection Syndrome ◽

Advanced Hiv Disease ◽

Inflammatory Syndrome

Parasitic infections such as Strongyloides stercoralis and HIV have been reported to coexist, particularly in resource-limited settings such as India. In an immunocompromised host, S. stercoralis can progress to strongyloidiasis hyperinfection syndrome (SHS). However, SHS is not common in patients with advanced HIV disease. Immune reconstitution inflammatory syndrome (IRIS) developing after initiation of antiretroviral therapy (ART) can target multiple pathogens including S. stercoralis. The authors present here a 46-year-old HIV-infected female who was recently diagnosed with HIV-1 infection, started ART, and developed SHS. Her upper GI endoscopy revealed severe gastroduodenitis, and X-ray chest showed extensive bilateral pneumonitis. We could identify S. stercoralis in induced sputum and duodenal biopsy. We could also identify gut inflammation to restrict invading parasites. After receiving antihelminthic therapy, she showed improvement, a course of events that fit the diagnosis of unmasking S. stercoralis IRIS.

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Immune reconstitution inflammatory syndrome among adolescents: A report of cases in a resource-limited setting (Uganda)

Southern African Journal of HIV Medicine ◽

10.4102/sajhivmed.v11i2.225 ◽

2010 ◽

Vol 11 (2) ◽

Author(s):

Christine Katusiime ◽

Ponsiano Ocama ◽

Andrew Kambugu

Keyword(s):

Young Adults ◽

Infectious Diseases ◽

Immune Reconstitution Inflammatory Syndrome ◽

Immune Reconstitution ◽

Resource Limited Setting ◽

Resource Limited ◽

Inflammatory Syndrome ◽

Limited Setting

We report immune reconstitution inflammatory syndromes in a cohort of adolescents/young adults over a period of 1 year at the Infectious Diseases Institute, Kampala, Uganda.

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