PMID- 16894096
OWN - NLM
STAT- MEDLINE
DCOM- 20060906
LR  - 20161118
IS  - 1526-632X (Electronic)
IS  - 0028-3878 (Linking)
VI  - 67
IP  - 3
DP  - 2006 Aug 8
TI  - Immune reconstitution inflammatory syndrome in the CNS of HIV-infected patients.
PG  - 383-8
AB  - OBJECTIVE: To describe challenges in diagnosis and management of patients with 
      clinical syndromes of immune reconstitution inflammatory syndrome (IRIS) 
      involving the CNS. METHODS: The authors describe three patients with clinically 
      distinct neurologic manifestations of IRIS with HIV infection who presented as 
      diagnostic and therapeutic challenges. RESULTS: One patient with cryptococcal 
      meningitis developed acute cerebellitis with mass effect and brainstem 
      compression. Corticosteroid therapy was associated with complete resolution of 
      the cerebellar lesion but the patient developed VZV encephalitis. Another patient 
      with progressive multifocal leukoencephalopathy developed subacute progression of 
      focal neurologic deficits associated with contrast enhancing lesions on brain 
      MRI. This patient had spontaneous resolution of the lesion but was left with 
      residual deficits. One patient developed a progressive dementing syndrome and 
      deterioration over several months resulting in coma during combination 
      antiretroviral therapy. A brain biopsy in this latter patient showed massive 
      infiltration of T lymphocytes predominantly of the CD8 subtype. This patient had 
      a significant improvement with corticosteroids and change in antiretroviral 
      regimen although she was left with residual cognitive impairment. CONCLUSIONS: 
      Immune reconstitution inflammatory syndrome should be suspected in patients who 
      show clinical or radiologic deterioration following initiation of antiretroviral 
      therapy accompanied with improvement in CD4 cell count and viral load. Some 
      patients may respond to a brief course of treatment with corticosteroids.
FAU - Venkataramana, A
AU  - Venkataramana A
AD  - Department of Neurology, Johns Hopkins University, Baltimore, MD 21287, USA.
FAU - Pardo, C A
AU  - Pardo CA
FAU - McArthur, J C
AU  - McArthur JC
FAU - Kerr, D A
AU  - Kerr DA
FAU - Irani, D N
AU  - Irani DN
FAU - Griffin, J W
AU  - Griffin JW
FAU - Burger, P
AU  - Burger P
FAU - Reich, D S
AU  - Reich DS
FAU - Calabresi, P A
AU  - Calabresi PA
FAU - Nath, A
AU  - Nath A
LA  - eng
GR  - K08 DA016160/DA/NIDA NIH HHS/United States
GR  - K08 DA016160-04/DA/NIDA NIH HHS/United States
PT  - Journal Article
PL  - United States
TA  - Neurology
JT  - Neurology
JID - 0401060
RN  - 0 (Adrenal Cortex Hormones)
SB  - IM
MH  - AIDS-Related Opportunistic Infections
MH  - Adrenal Cortex Hormones/*therapeutic use
MH  - Antiretroviral Therapy, Highly Active
MH  - Autoimmune Diseases of the Nervous System/*drug therapy/*etiology/virology
MH  - CD4 Lymphocyte Count
MH  - Central Nervous System Diseases/etiology/virology
MH  - HIV Infections/*complications/drug therapy
MH  - Humans
MH  - Viral Load
EDAT- 2006/08/09 09:00
MHDA- 2006/09/07 09:00
CRDT- 2006/08/09 09:00
PHST- 2006/08/09 09:00 [pubmed]
PHST- 2006/09/07 09:00 [medline]
PHST- 2006/08/09 09:00 [entrez]
AID - 67/3/383 [pii]
AID - 10.1212/01.wnl.0000227922.22293.93 [doi]
PST - ppublish
SO  - Neurology. 2006 Aug 8;67(3):383-8. doi: 10.1212/01.wnl.0000227922.22293.93.