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Isolating Central Nervous System Tissues and Associated Meninges for the Downstream Analysis of Immune cells
09:35

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Published on: May 19, 2020

[Immune reconstitution inflammatory syndrome in cryptococcal meningitis: a rare phenomenon?]

K Schulze1, S Schmiedel, J van Lunzen

  • 1Sektion Infektiologie und Tropenmedizin, I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf. kschulze@uke.de

Deutsche Medizinische Wochenschrift (1946)
|April 13, 2012
PubMed

Insights

Cryptococcal meningitis can occur in untreated HIV patients. Immune reconstitution inflammatory syndrome (IRIS) is a key differential diagnosis for atypical disease courses, treatable with steroids.

Area of Science:

  • Infectious Diseases
  • Neurology
  • Immunology

Background:

  • Human Immunodeficiency Virus (HIV) infection can lead to opportunistic infections, including cryptococcal meningitis.
  • Cryptococcal meningitis presents with neurological symptoms such as headache, photophobia, and nausea.
  • Early diagnosis and treatment are crucial for managing cryptococcal meningitis in HIV patients.

Observation:

  • A patient with untreated HIV presented with symptoms suggestive of meningitis.
  • Diagnosis of cryptococcal meningitis was confirmed by cerebrospinal fluid analysis, including India ink stain, culture, and antigen testing.
  • The patient experienced a worsening clinical course despite initial antifungal and antiretroviral therapy.

Findings:

  • The patient was diagnosed with cryptococcal meningitis and subsequently developed immune reconstitution inflammatory syndrome (IRIS).
  • IRIS, a complication of antiretroviral therapy initiation in HIV-associated infections, presented atypically.
  • Adjuvant steroid treatment led to clinical improvement within six months.

Implications:

  • Cryptococcal meningitis should be considered in HIV patients with neurological symptoms.
  • India ink stain, CSF culture, and antigen detection are vital diagnostic tools.
  • IRIS is a critical differential diagnosis for atypical presentations of HIV-associated infections and is effectively managed with steroids.
Abstract

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