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Síndrome de restauración inmune asociado a tratamiento antirretroviral y criptococosis meníngea: Caso clínico / Inflammatory reconstitution immune syndrome associated to antiretroviral therapy and meningeal cryptococcosis
Sáez M., David; Bahamondes M., Laura; Lam E., Gislaine; Arellano R., Luz; Lillo Z., Patricia.
Affiliation
  • Sáez M., David; Hospital Barros Luco-Trudeau. Servicio de Neurología. Santiago. CL
  • Bahamondes M., Laura; Hospital de Enfermedades Infecciosas Dr. Lucio Córdova. Santiago. CL
  • Lam E., Gislaine; Hospital Barros Luco-Trudeau. Servicio de Neurología. Santiago. CL
  • Arellano R., Luz; Universidad de Chile. Departamento de Neurología Campus Sur. Santiago. CL
  • Lillo Z., Patricia; Hospital Barros Luco-Trudeau. Servicio de Neurología. Santiago. CL
Rev. méd. Chile ; 134(10): 1310-1314, oct. 2006. ilus
Article in Spanish | LILACS | ID: lil-439924
Responsible library: BR1.1
ABSTRACT
The objective of high activity antiretroviral therapy (HAART) in patients with AIDS, is to obtain immune restoration. This means a reduction of the viral load and restitution of the CD4 cell count. A decreased rate of HIV replication improves both the number and function of CD4 cells. Nevertheless, this treatment sometimes results in the reappearance of previous symptoms from treated conditions due to opportunistic infections (ie tuberculosis, criptococcosis, hepatitis, Pneumocystis jirovesi, toxoplasmosis, etc) or non infectious condition such as sarcoidosis, Graves disease or Kaposi sarcoma. This is known as Inflammatory Reconstitution Immune Syndrome (IRIS). We report a 37 year-old woman in stage C3-AIDS with a previous criptococcal meningitis. She was treated, achieving a marked improvement with treatment and subsequent suppressive therapy with fluconazole 200 mg/day. IRIS appeared after 8 months of ongoing antiretroviral therapy with immune restoration with the development of aseptic meningitis and intracranial hypertension. The opportunistic agent could not be identified by cultures. Additional laboratory tests excluded toxoplasmosis, tuberculosis, bacterial cerebral abscesses, syphilitic cerebral gummas, and lymphoma. Brain CT and magnetic resonance studies were compatible with brain vasculitis and leptomeningitis. The patient condition improved with general measures, such as a repeated lumbar punctures and non steroidal anti-inflammatory drugs. We conclude that this patient had an IRIS due to a Cryptococcus neoformans antigen.
Subject(s)
Full text: Available Collection: International databases Health context: SDG3 - Health and Well-Being / Neglected Diseases / SDG3 - Target 3.3 End transmission of communicable diseases Health problem: Target 3.3: End transmission of communicable diseases / Tuberculosis / Zoonoses / Meningitis Database: LILACS Main subject: Acquired Immunodeficiency Syndrome / Meningitis, Cryptococcal / AIDS-Related Opportunistic Infections / Antiretroviral Therapy, Highly Active / Immune Reconstitution Inflammatory Syndrome Type of study: Prognostic study / Risk factors Limits: Adult / Female / Humans Language: Spanish Journal: Rev. méd. Chile Journal subject: Medicine Year: 2006 Document type: Article Affiliation country: Chile Institution/Affiliation country: Hospital Barros Luco-Trudeau/CL / Hospital de Enfermedades Infecciosas Dr. Lucio Córdova/CL / Universidad de Chile/CL
Full text: Available Collection: International databases Health context: SDG3 - Health and Well-Being / Neglected Diseases / SDG3 - Target 3.3 End transmission of communicable diseases Health problem: Target 3.3: End transmission of communicable diseases / Tuberculosis / Zoonoses / Meningitis Database: LILACS Main subject: Acquired Immunodeficiency Syndrome / Meningitis, Cryptococcal / AIDS-Related Opportunistic Infections / Antiretroviral Therapy, Highly Active / Immune Reconstitution Inflammatory Syndrome Type of study: Prognostic study / Risk factors Limits: Adult / Female / Humans Language: Spanish Journal: Rev. méd. Chile Journal subject: Medicine Year: 2006 Document type: Article Affiliation country: Chile Institution/Affiliation country: Hospital Barros Luco-Trudeau/CL / Hospital de Enfermedades Infecciosas Dr. Lucio Córdova/CL / Universidad de Chile/CL
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