Case Report: Paradoxical Inflammatory Response Syndrome in a Previously Healthy, HIV-Negative, Pediatric Patient With

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Sequencing of Bacterial Microflora in Peripheral Blood: our Experience with HIV-infected Patients

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Jessica H Cheng1, Ritu Cheema2, Peter R Williamson3

  • 1Department of Pediatrics, UC Davis Health, Sacramento, CA, United States.

Frontiers in Pediatrics
|September 13, 2021
PubMed

Insights

A rare inflammatory syndrome (PIIRS) can occur after cryptococcal meningitis (CM) treatment, even in healthy individuals. Steroids helped manage this in a pediatric case, highlighting the need for careful monitoring and future therapies.

Area of Science:

  • Neuroimmunology
  • Infectious Diseases
  • Pediatric Neurology

Background:

  • Cryptococcal meningitis (CM) presents significant morbidity and mortality.
  • Post-infectious inflammatory response syndrome (PIIRS) is a serious sequela of CM, causing immune-mediated CNS damage.
  • PIIRS management in pediatric patients, especially those not immunocompromised, requires further investigation.

Observation:

  • A previously healthy adolescent male with *Cryptococcus gattii* meningitis developed neurological deterioration due to PIIRS after antifungal therapy.
  • Immunological workup, including genetic screening, did not reveal underlying immunodeficiencies.
  • The patient experienced clinical recovery with steroid treatment, but required management for recurrent inflammatory episodes.

Findings:

  • Steroid therapy demonstrated efficacy in managing PIIRS in this pediatric case.
  • The case underscores the potential for PIIRS in immunocompetent individuals following CM.
  • Successful management involved addressing intermittent inflammatory flares.

Implications:

  • This case highlights the importance of recognizing and managing PIIRS in pediatric cryptococcal meningitis.
  • Steroids represent a viable treatment option for PIIRS in children.
  • Further research into targeted therapies for PIIRS is warranted to prevent long-term neurological sequelae.
Keywords:
IL-6cryptococcal meningitisimmunocompetentpediatricspost-infectious inflammatory response syndrome

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