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HIV combination therapy: immune restitution causing cryptococcal lymphadenitis dramatically improved by
P Blanche1, B Gombert, C Ginsburg
1Service de Médecine Interne 2, Hôpital Cochin, Université René Descartes, Paris, France.
Scandinavian Journal of Infectious Diseases
|May 4, 1999
Summary
Highly active antiretroviral therapy (HAART) did not prevent focal cryptococcal lymphadenitis in two AIDS patients. Anti-inflammatory drugs proved effective when antifungals failed, suggesting a novel treatment approach.
Area of Science:
- Infectious Diseases
- Immunology
- Oncology
Background:
- Highly active antiretroviral therapy (HAART) has transformed HIV/AIDS management.
- Opportunistic infections remain a concern even with effective antiretroviral treatment.
- Cryptococcal infections, particularly meningitis, are significant complications in advanced HIV disease.
Observation:
- Two patients with acquired immunodeficiency syndrome (AIDS) developed focal cryptococcal lymphadenitis.
- These patients were on HAART for 8 and 15 months, respectively.
- Both patients had received fluconazole for secondary prophylaxis against prior cryptococcal meningitis.
Findings:
- Despite HAART and antifungal prophylaxis, Cryptococcus neoformans was identified microscopically in lymph nodes.
- Standard antifungal treatments, including amphotericin, were ineffective.
- Administration of anti-inflammatory drugs resulted in a dramatic positive effect on the condition.
Implications:
- Focal cryptococcal lymphadenitis can occur in patients with AIDS on HAART.
- Conventional antifungal therapies may be insufficient for this specific presentation.
- Anti-inflammatory agents may represent a promising therapeutic strategy for cryptococcal lymphadenitis in immunocompromised individuals.