A case report of a brain herniation secondary to cryptococcal meningitis with elevated intracranial pressure in a patient with Human Immunodeficiency Virus/Acquired immunodeficiency syndrome (HIV/AIDS)

Guevara, Nehemias; Akande, Abdulrasheed; Chang, Mailing Flores; Atallah, Jane; Epstein, Carol

doi:10.1016/j.idcr.2022.e01554

Cited by 2 publications

(5 citation statements)

References 37 publications

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“…Because pulmonary manifestations have been reported in C-IRIS patients 3 , 8 , 12 , we examined if our previously established C-IRIS model 13 (CnH99 preinfection for three weeks followed by CD4 + T cell transfer into Rag1 −/− mice) would show any pulmonary dysfunctions. At five days after CD4 + T cell transfer, respiratory rate was significantly reduced in the C-IRIS group compared with the three control cohorts (naive Rag1 −/− mice, Rag1 −/− mice with CnH99 infection alone, and Rag1 −/− mice with CD4 + T cell transfer alone) (Supplementary Fig.…”

Section: Resultsmentioning

confidence: 99%

“…C-IRIS patients can present with pulmonary disease, for instance, respiratory distress, pulmonary nodules and pleural effusions 3 , 8 , 12 . In this study, we analyzed pulmonary functions via SomnoSuite and WBP.…”

Section: Discussionmentioning

confidence: 99%

“…Although our mouse model mimics human C-IRIS, the inherent differences in biology and immune responses between the mouse C-IRIS model and human C-IRIS situation should not be ignored. For instance, C-IRIS patients develop respiratory failure at the point of brain/uncal herniation 12 . However, although our C-IRIS model mice show brain edema 13 , which may trigger brain herniation, such mice do not show brain/uncal herniation when mice develop respiratory failure.…”

Section: Discussionmentioning

confidence: 99%

“…However, it would be an interesting future topic to examine the efficacy of Cn52D with a high dose and different induction paradigm. C-IRIS patients can present with pulmonary disease, for instance, respiratory distress, pulmonary nodules and pleural effusions 3,8,12 . In this study, we analyzed pulmonary functions via SomnoSuite and WBP.…”

Section: Discussionmentioning

confidence: 99%

“…A retrospective cohort study shows that pulmonary disease occurs in approximately 20% of C-IRIS cases 8 , such that patients may present with brain/uncal herniation 12 , pulmonary nodules 3 , 8 , and pleural effusions, which are rarely encountered 8 . Despite the reports, little is understood about its etiology and pathogenesis, making clinical diagnosis and treatment highly inefficient.…”

Section: Introductionmentioning

confidence: 99%

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T cell infiltration into the brain triggers pulmonary dysfunction in murine Cryptococcus-associated IRIS

Kawano,

Zhou,

Anwar

et al. 2023

Nat Commun

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Cryptococcus-associated immune reconstitution inflammatory syndrome (C-IRIS) is a condition frequently occurring in immunocompromised patients receiving antiretroviral therapy. C-IRIS patients exhibit many critical symptoms, including pulmonary distress, potentially complicating the progression and recovery from this condition. Here, utilizing our previously established mouse model of unmasking C-IRIS (CnH99 preinfection and adoptive transfer of CD4+ T cells), we demonstrated that pulmonary dysfunction associated with the C-IRIS condition in mice could be attributed to the infiltration of CD4+ T cells into the brain via the CCL8-CCR5 axis, which triggers the nucleus tractus solitarius (NTS) neuronal damage and neuronal disconnection via upregulated ephrin B3 and semaphorin 6B in CD4+ T cells. Our findings provide unique insight into the mechanism behind pulmonary dysfunction in C-IRIS and nominate potential therapeutic targets for treatment.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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T cell infiltration into the brain triggers pulmonary dysfunction in murine Cryptococcus-associated IRIS

Kawano,

Zhou,

Anwar

et al. 2023

Nat Commun

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Cryptococcal Meningitis in an Immunocompetent Patient With Underlying Risk Factors

Untalan,

Chinchanikar,

Arty

et al. 2024

Cureus

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Cryptococcal meningitis, a severe fungal infection of the central nervous system, is usually found in immunocompromised patients, especially those with human immunodeficiency virus/acquired immunodeficiency syndrome. Its occurrence in immunocompetent individuals is rare and the presentation can be nonspecific. We present a case of cryptococcal meningitis in a young, immunocompetent male with a known history of intravenous drug abuse who was also found to have hepatitis C during admission. Induction therapy with amphotericin B and flucytosine was completed for 14 days. This shorter duration was considered as he had a good clinical response with rapid improvement in mental status and intracranial pressure with an extraventricular drain and negative repeat cerebrospinal fluid (CSF) culture. However, during the consolidation phase with fluconazole, the patient developed new neurologic symptoms and the induction phase had to be re-initiated for a total of 28 days. The patient likewise required the re-placement of an extraventricular drain and the creation of a ventriculoperitoneal shunt due to persistent CSF accumulation and increased intracranial pressure. He was eventually discharged on fluconazole for a planned consolidation phase of eight weeks, followed by a prolonged maintenance phase, but the patient was lost to follow-up.

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A case report of a brain herniation secondary to cryptococcal meningitis with elevated intracranial pressure in a patient with Human Immunodeficiency Virus/Acquired immunodeficiency syndrome (HIV/AIDS)

Cited by 2 publications

References 37 publications

T cell infiltration into the brain triggers pulmonary dysfunction in murine Cryptococcus-associated IRIS

T cell infiltration into the brain triggers pulmonary dysfunction in murine Cryptococcus-associated IRIS

Cryptococcal Meningitis in an Immunocompetent Patient With Underlying Risk Factors

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