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Paradoxical cryptococcal immune reconstitution inflammatory syndrome in advanced chronic kidney disease
Chih-Chin Kao1, Vin-Cent Wu, Hsin-Yun Sun
1Division of Nephrology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
Abstract:
Cryptococcal-related immune reconstitution inflammatory syndrome (IRIS) is frequently seen in immunocompromised patients. A 45-year-old man with advanced chronic kidney disease (CKD) received intensive antifungal treatment for pulmonary cryptococcosis. Despite negative pleural effusion cultures and declining serum cryptococcal antigen titers, the patient presented with progressive pulmonary infiltration, intermittent fever, and elevated C-reactive protein. Steroids were given for suspected IRIS, and the clinical condition improved dramatically. This is the first report on paradoxical cryptococcal IRIS in a patient with advanced CKD.
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