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Successful treatment of Cryptococcus neoformans immune reconstitution inflammatory syndrome in an immunocompetent

Lucy K Somerville1, Andrew P Henderson2, Sharon C A Chen3

  • 1Centre for Infectious Diseases and Microbiology Laboratory Services, Level 3 Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, New South Wales 2145, Australia.

Medical Mycology Case Reports
|June 23, 2016
PubMed

Insights

Immune reconstitution inflammatory syndrome (IRIS) can complicate antifungal treatment for cryptococcosis. Thalidomide successfully treated cryptococcal IRIS in an immunocompetent patient after corticosteroids failed.

Area of Science:

  • Infectious Diseases
  • Immunology
  • Neurology

Background:

  • Immune reconstitution inflammatory syndrome (IRIS) is a known complication of antifungal therapy for cryptococcosis.
  • Limited data exist on the optimal management of cryptococcal-associated IRIS.

Purpose of the Study:

  • To describe the successful management of cryptococcal-associated IRIS in an immunocompetent patient.
  • To highlight thalidomide as a potential treatment option for refractory cases.

Main Methods:

  • Case report of an immunocompetent patient with Cryptococcus neoformans meningitis.
  • Description of IRIS development during antifungal treatment.
  • Evaluation of thalidomide therapy after corticosteroid failure.

Main Results:

  • The patient developed IRIS complicating Cryptococcus neoformans meningitis.
  • Corticosteroid therapy was ineffective in managing the IRIS.
  • Thalidomide treatment resulted in successful resolution of IRIS.

Conclusions:

  • Thalidomide can be an effective treatment for cryptococcal IRIS in immunocompetent individuals.
  • Further data are needed to confirm the role of thalidomide in managing cryptococcal IRIS.

Keywords:
Cryptococcus neoformansImmune reconstitutionThalidomide

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