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Paradoxical immune reconstitution inflammatory syndrome due to toxoplasmic encephalitis: two cases and review of initiation of antiretroviral timing in toxoplasmic encephalitis IRIS.

Dinardo AR, Lewis DS, Koo HL, Goodman JC, Chiao E, Andrade R - F1000Res (2013)

Bottom Line: To the best of our knowledge, only two cases of paradoxical TE-IRIS and nine cases of unmasking TE-IRIS have been previously described.We present two additional cases of histopathology-consistent paradoxical TE-IRIS, after early initiation of antiretroviral therapy (ART), and review the literature on TE-IRIS.Three of the four reported cases of paradoxical TE-IRIS were associated with early (within one week) initiation of ART, an issue that was not addressed in the 2009 US Department of Health and Human Services guidelines for the treatment of opportunistic infections.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA.

ABSTRACT
Toxoplasma encephalitis immune reconstitution inflammatory syndrome (TE-IRIS) is rare and usually occurs in an unmasking, rather than paradoxical form. To the best of our knowledge, only two cases of paradoxical TE-IRIS and nine cases of unmasking TE-IRIS have been previously described. We present two additional cases of histopathology-consistent paradoxical TE-IRIS, after early initiation of antiretroviral therapy (ART), and review the literature on TE-IRIS. Three of the four reported cases of paradoxical TE-IRIS were associated with early (within one week) initiation of ART, an issue that was not addressed in the 2009 US Department of Health and Human Services guidelines for the treatment of opportunistic infections.

No MeSH data available.


Related in: MedlinePlus

Brain MRI of patient 2 at presentation showed an irregular ring-enhancing lesion in the right frontoparietal region with maximal transverse dimension of 2.2 cm (A). After 10 days of anti-toxoplasma treatment and antiretroviral therapy, follow-up MRI revealed no significant interval change of enhancing frontoparietal lesion (B).
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f3: Brain MRI of patient 2 at presentation showed an irregular ring-enhancing lesion in the right frontoparietal region with maximal transverse dimension of 2.2 cm (A). After 10 days of anti-toxoplasma treatment and antiretroviral therapy, follow-up MRI revealed no significant interval change of enhancing frontoparietal lesion (B).

Mentions: His CD4 count was 152 (13%) cells/µl and his viral load was 433,000 copies/ml.Toxoplasma IgG was positive. An MRI revealed multiple ring-enhancing lesions in his frontoparietal region (Figure 3A). CSF showed 6 WBCs (100% lymphocytes), undetectable JC virus DNA and no malignant cells on cytopathology or flow cytometry. On day two, the patient was started on pyrimethamine, sulfadiazine and leucovorin, as well as lopinavir-ritonavir, tenofovir and emtricitabine.


Paradoxical immune reconstitution inflammatory syndrome due to toxoplasmic encephalitis: two cases and review of initiation of antiretroviral timing in toxoplasmic encephalitis IRIS.

Dinardo AR, Lewis DS, Koo HL, Goodman JC, Chiao E, Andrade R - F1000Res (2013)

Brain MRI of patient 2 at presentation showed an irregular ring-enhancing lesion in the right frontoparietal region with maximal transverse dimension of 2.2 cm (A). After 10 days of anti-toxoplasma treatment and antiretroviral therapy, follow-up MRI revealed no significant interval change of enhancing frontoparietal lesion (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3814919&req=5

f3: Brain MRI of patient 2 at presentation showed an irregular ring-enhancing lesion in the right frontoparietal region with maximal transverse dimension of 2.2 cm (A). After 10 days of anti-toxoplasma treatment and antiretroviral therapy, follow-up MRI revealed no significant interval change of enhancing frontoparietal lesion (B).
Mentions: His CD4 count was 152 (13%) cells/µl and his viral load was 433,000 copies/ml.Toxoplasma IgG was positive. An MRI revealed multiple ring-enhancing lesions in his frontoparietal region (Figure 3A). CSF showed 6 WBCs (100% lymphocytes), undetectable JC virus DNA and no malignant cells on cytopathology or flow cytometry. On day two, the patient was started on pyrimethamine, sulfadiazine and leucovorin, as well as lopinavir-ritonavir, tenofovir and emtricitabine.

Bottom Line: To the best of our knowledge, only two cases of paradoxical TE-IRIS and nine cases of unmasking TE-IRIS have been previously described.We present two additional cases of histopathology-consistent paradoxical TE-IRIS, after early initiation of antiretroviral therapy (ART), and review the literature on TE-IRIS.Three of the four reported cases of paradoxical TE-IRIS were associated with early (within one week) initiation of ART, an issue that was not addressed in the 2009 US Department of Health and Human Services guidelines for the treatment of opportunistic infections.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA.

ABSTRACT
Toxoplasma encephalitis immune reconstitution inflammatory syndrome (TE-IRIS) is rare and usually occurs in an unmasking, rather than paradoxical form. To the best of our knowledge, only two cases of paradoxical TE-IRIS and nine cases of unmasking TE-IRIS have been previously described. We present two additional cases of histopathology-consistent paradoxical TE-IRIS, after early initiation of antiretroviral therapy (ART), and review the literature on TE-IRIS. Three of the four reported cases of paradoxical TE-IRIS were associated with early (within one week) initiation of ART, an issue that was not addressed in the 2009 US Department of Health and Human Services guidelines for the treatment of opportunistic infections.

No MeSH data available.


Related in: MedlinePlus