Treatment of HIV‐Related Inflammatory Cerebral Cryptococcoma with Adalimumab

Sitapati, Amy M.; Kao, Cynthia L.; Cachay, Edward R.; Masoumi, Homeyra; Wallis, Robert S.; Mathews, W. Christopher

doi:10.1086/649553

Cited by 53 publications

(39 citation statements)

References 12 publications

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“…There have been several case reports documenting neurologic improvement with the use of thalidomide, a TNF-α inhibitor, in steroid dependent or refractory cases of C-IRIS (78). Adalimumab, a human monoclonal antibody that binds to TNFα, blocking its anti-inflammatory actions demonstrated neurological improvement in a patient with IRIS associated cryptococcoma (79). Both thalidomide and adalimumab were used after documented sterility of the CSF.…”

Section: Cryptococcal Meningitis Relapsementioning

confidence: 99%

Cryptococcal Meningitis: Diagnosis and Management Update

2015

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Recent advances in the diagnosis and management of cryptococcal meningitis are promising and have been improving long-term survival. Point of care testing has made diagnosing cryptococcal meningitis rapid, practical, and affordable. Targeted screening and treatment programs for cryptococcal antigenemia are a cost effective method for reducing early mortality on antiretroviral therapy (ART). Optimal initial management with amphotericin and flucytosine improves survival against alternative therapies, although amphotericin is difficult to administer and flucytosine is not available in middle or low income countries, where cryptococcal meningitis is most prevalent. Controlling increased intracranial pressure with serial therapeutic lumbar punctures has a proven survival benefit. Delaying ART initiation for 4 weeks after the diagnosis of cryptococcal meningitis is associated with improved survival. Fortunately, new approaches have been leading the way toward improving care for cryptococcal meningitis patients. New trials utilizing different combinations of antifungal therapy are reviewed, and we summarize the efficacy of different regimens.

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Section: Cryptococcal Meningitis Relapsementioning

confidence: 99%

Cryptococcal Meningitis: Diagnosis and Management Update

2015

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“…In paradoxical C-IRIS, specimen cultures are classically sterile,6 7 13 15 25 33 34 but in cryptococcal meningitis, they frequently reveal viable organisms 31 35–37. Histological findings in paradoxical C-IRIS include the presence of inactive cryptococcal species or fungal elements, inflammation, granulomas and necrotic material 6 7 33 38 39…”

Section: Discussionmentioning

confidence: 99%

A paradoxical decline: intracranial lesions in two HIV-positive patients recovering from cryptococcal meningitis

et al. 2015

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Cryptococcal immune reconstitution inflammatory syndrome (C-IRIS) is an increasingly important manifestation among patients with HIV/AIDS, especially as the use of antiretroviral therapy (ART) is expanding worldwide. Cryptococcus and associated C-IRIS are common causes of meningitis. While intracranial lesions are common in HIV/AIDS, they are rarely due to cryptococcosis or C-IRIS. We describe two cases of paradoxical C-IRIS associated with the development of intracranial cryptococcomas in HIV/AIDS. Both patients had an initial episode of cryptococcal meningitis treated with antifungal therapy. At the time, they had initiated or modified ART with subsequent evidence of immune reconstitution. Two months later, they developed aseptic meningitis with intracranial lesions. After exhaustive work ups, both patients were diagnosed with paradoxical C-IRIS and biopsy confirmed intracranial cryptococcomas. We review the important clinical, diagnostic and therapeutic features of cryptococcomas associated with C-IRIS in HIV/AIDS.

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“…Voriconazole, miconazole, and neurosurgery have all been reported as successful salvage therapies [15,17], though systematic studies have not been conducted. Interestingly, Adalimumab, a recombinant human immunoglobulin G1 monoclonal antibody specific for human TNF alpha, has also been used to successfully treat a cryptococcoma [16].…”

Section: Discussionmentioning

confidence: 99%

Central nervous system cryptococcoma in a Ugandan patient with Human Immunodeficiency Virus

Velamakanni

Bahr

Musubire

et al. 2014

Medical Mycology Case Reports

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Mortality due to AIDS-related Cryptococcal meningitis (CM) is often >50% in low-middle income countries. Dissemination of CM can result in intracranial mass lesions known as cryptococcoma. Patients who develop cryptococcomas often have worse outcomes when compared to patients with cryptococcosis without cryptococcoma. We describe a cryptococcoma in the central nervous system (CNS) in a Ugandan patient with AIDS, and review the diagnosis and management with special focus on difficulties encountered in low or middle-income countries.

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Treatment of HIV‐Related Inflammatory Cerebral Cryptococcoma with Adalimumab

Cited by 53 publications

References 12 publications

Cryptococcal Meningitis: Diagnosis and Management Update

Cryptococcal Meningitis: Diagnosis and Management Update

A paradoxical decline: intracranial lesions in two HIV-positive patients recovering from cryptococcal meningitis

Central nervous system cryptococcoma in a Ugandan patient with Human Immunodeficiency Virus

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