Fatal immune reconstitution inflammatory syndrome with human immunodeficiency virus infection andCandidameningitis: Case report and review of the literature

Abstract

Immune reconstitution inflammatory syndrome (IRIS) is an increasingly recognized phenomenon of paradoxical worsening of patients with acquired immunodeficiency syndrome (AIDS) upon initiation of highly active antiretroviral therapy (HAART). To date, there have been limited reports of IRIS in the central nervous system (CNS). Here, the authors describe a 43-year-old man with AIDS who presented with subacute meningitis. No pathogenic organism was identified by routine diagnostic tests, and he was treated empirically with an antituberculous regimen and initiated on HAART therapy. Soon after, he had a precipitous neurologic decline leading to his death. Postmortem evaluation showed a basilar Candida meningitis as well as vasculitis characterized by CD8+ T-cell infiltration, consistent with IRIS. The authors discuss the challenges in diagnosing fungal meningitides and the risks of initiating HAART therapy in those with possible undiagnosed underlying opportunistic infections. Additionally, the authors review the literature regarding CNS IRIS.

Neurologic Complications of HIV-1 Infection and Its Treatment in the Era of Antiretroviral Therapy

“…Postmortem examination revealed basilar Candida sp meningitis as well as CD8+ T-cell perivascular infiltrates, particularly in the brainstem. 63 …”

Central nervous system immune reconstitution inflammatory syndrome (IRIS) after hematopoietic SCT

“…2 Infections associated with IRIS include those caused by Mycobacterium tuberculosis, Mycobacterium Avium-Intracellulare (MAI), Cryptococcus neoformans, CMV, JC virus and Candida. 1,3 We report a case of IRIS in a non-HIV-positive patient, who developed a severe form of CNS IRIS after treatment of CML with allogeneic hematopoietic SCT (HSCT). (Table 1).…”

Immune reconstitution inflammatory syndrome and the central nervous system

“…Cryptococcus IRIS is mainly mediated by CD4 þ T cells and macrophages, whereas Candida IRIS involves CD8 þ T cells [24,26]. The differing roles of immune cells predominant in the CNS may reflect different disease mechanisms.…”

“…Fungal pathogens associated with CNS-IRIS include Cryptococcus neoformans and Candida, most often presenting as meningitis, intracranial cryptococcoma and cervical lymphadenitis [24][25][26]. Cryptococcus IRIS is mainly mediated by CD4 þ T cells and macrophages, whereas Candida IRIS involves CD8 þ T cells [24,26].…”