Limits...
Immune Reconstitution Inflammatory Syndrome in Acquired Immune Deficiency Syndrome related to Cryptococcal Meningoencephalitis.

Park JY, Kim MJ - J Investig Med High Impact Case Rep (2014)

Bottom Line: A diagnosis of central nervous system (CNS)-IRIS was based on a decrease of HIV-RNA viral load greater than 1 log, with an increase in CD4(+) T-cell count from baseline.Conclusions.Differential diagnosis of this paradoxical deterioration in clinical and neurological status from overwhelming opportunistic infection is important; it enables an avoidance of unnecessary diagnostic procedures and proper management of this HIV-associated CNS disorder.

View Article: PubMed Central - PubMed

Affiliation: Kosin University College of Medicine, Busan, Korea.

ABSTRACT
Background. Highly active antiretroviral therapy (HAART) has contributed to reducing the occurrence of opportunistic infections and mortality in human immunodeficiency virus (HIV) infected patients. However, a paradoxical worsening of clinical signs and symptoms among patients during HAART may occur. Immune reconstitution inflammatory syndrome (IRIS) is described as a paradoxical deterioration of clinical status on initiation of HAART in patients with HIV infection. Case Report. We describe the case of a 41-year-old man with opportunistic cryptococcal encephalitis who exhibited neurological and radiological deterioration during the course of HAART. A diagnosis of central nervous system (CNS)-IRIS was based on a decrease of HIV-RNA viral load greater than 1 log, with an increase in CD4(+) T-cell count from baseline. Conclusions. Differential diagnosis of this paradoxical deterioration in clinical and neurological status from overwhelming opportunistic infection is important; it enables an avoidance of unnecessary diagnostic procedures and proper management of this HIV-associated CNS disorder.

No MeSH data available.


Related in: MedlinePlus

Follow-up axial FLAIR (A-D) and T1WI postcontrast (E-H) imaging show subtle focal hyperintensities without mass effect. No abnormal enhancing lesions are seen in parenchymes but asymmetric focal prominent leptomeningeal enhancement in right parietal cortex is noted.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
getmorefigures.php?uid=PMC4528883&req=5

fig3-2324709614533951: Follow-up axial FLAIR (A-D) and T1WI postcontrast (E-H) imaging show subtle focal hyperintensities without mass effect. No abnormal enhancing lesions are seen in parenchymes but asymmetric focal prominent leptomeningeal enhancement in right parietal cortex is noted.

Mentions: Five months later, in June 2012, he presented with slurred speech and general weakness. There was no fever and hypertension. Neurologic examination revealed mild dysarthria and clumsiness in both hands. Lumbar puncture was performed and found to be unremarkable with CSF cryptococcal antigen being negative. Epstein–Barr virus, herpes simplex virus 1 and 2, cytomegalovirus, and varicellar zoster virus could not be detected by polymerase chain reaction (PCR), and toxoplasma antibody was not detected. In 2 consecutive CSF studies, JC virus PCR was also negative. Brain MRI demonstrated improved patchy T2 hyperintensities in the BG and thalami, but confluent symmetrical T2 hyperintensities were present in both parietotemporal and right occipital white matter. In contrast enhancement images, extensive leptomeningeal enhancement of both parietotemporal regions was seen (Figure 2). At this stage, CD4+ T-cell count was 221 cells/µL and HIV viral load was 47 copies/mL. The patient was diagnosed with IRIS and treated with intravenous methylprednisolone for 5 days. His antiretroviral treatment regimen was maintained. The neurologic abnormalities gradually improved over the next year, and follow-up MRI showed marked improvement (Figure 3).


Immune Reconstitution Inflammatory Syndrome in Acquired Immune Deficiency Syndrome related to Cryptococcal Meningoencephalitis.

Park JY, Kim MJ - J Investig Med High Impact Case Rep (2014)

Follow-up axial FLAIR (A-D) and T1WI postcontrast (E-H) imaging show subtle focal hyperintensities without mass effect. No abnormal enhancing lesions are seen in parenchymes but asymmetric focal prominent leptomeningeal enhancement in right parietal cortex is noted.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4528883&req=5

fig3-2324709614533951: Follow-up axial FLAIR (A-D) and T1WI postcontrast (E-H) imaging show subtle focal hyperintensities without mass effect. No abnormal enhancing lesions are seen in parenchymes but asymmetric focal prominent leptomeningeal enhancement in right parietal cortex is noted.
Mentions: Five months later, in June 2012, he presented with slurred speech and general weakness. There was no fever and hypertension. Neurologic examination revealed mild dysarthria and clumsiness in both hands. Lumbar puncture was performed and found to be unremarkable with CSF cryptococcal antigen being negative. Epstein–Barr virus, herpes simplex virus 1 and 2, cytomegalovirus, and varicellar zoster virus could not be detected by polymerase chain reaction (PCR), and toxoplasma antibody was not detected. In 2 consecutive CSF studies, JC virus PCR was also negative. Brain MRI demonstrated improved patchy T2 hyperintensities in the BG and thalami, but confluent symmetrical T2 hyperintensities were present in both parietotemporal and right occipital white matter. In contrast enhancement images, extensive leptomeningeal enhancement of both parietotemporal regions was seen (Figure 2). At this stage, CD4+ T-cell count was 221 cells/µL and HIV viral load was 47 copies/mL. The patient was diagnosed with IRIS and treated with intravenous methylprednisolone for 5 days. His antiretroviral treatment regimen was maintained. The neurologic abnormalities gradually improved over the next year, and follow-up MRI showed marked improvement (Figure 3).

Bottom Line: A diagnosis of central nervous system (CNS)-IRIS was based on a decrease of HIV-RNA viral load greater than 1 log, with an increase in CD4(+) T-cell count from baseline.Conclusions.Differential diagnosis of this paradoxical deterioration in clinical and neurological status from overwhelming opportunistic infection is important; it enables an avoidance of unnecessary diagnostic procedures and proper management of this HIV-associated CNS disorder.

View Article: PubMed Central - PubMed

Affiliation: Kosin University College of Medicine, Busan, Korea.

ABSTRACT
Background. Highly active antiretroviral therapy (HAART) has contributed to reducing the occurrence of opportunistic infections and mortality in human immunodeficiency virus (HIV) infected patients. However, a paradoxical worsening of clinical signs and symptoms among patients during HAART may occur. Immune reconstitution inflammatory syndrome (IRIS) is described as a paradoxical deterioration of clinical status on initiation of HAART in patients with HIV infection. Case Report. We describe the case of a 41-year-old man with opportunistic cryptococcal encephalitis who exhibited neurological and radiological deterioration during the course of HAART. A diagnosis of central nervous system (CNS)-IRIS was based on a decrease of HIV-RNA viral load greater than 1 log, with an increase in CD4(+) T-cell count from baseline. Conclusions. Differential diagnosis of this paradoxical deterioration in clinical and neurological status from overwhelming opportunistic infection is important; it enables an avoidance of unnecessary diagnostic procedures and proper management of this HIV-associated CNS disorder.

No MeSH data available.


Related in: MedlinePlus