PMID- 22495917
OWN - NLM
STAT- MEDLINE
DCOM- 20120529
LR  - 20140731
IS  - 1439-4413 (Electronic)
IS  - 0012-0472 (Linking)
VI  - 137
IP  - 16
DP  - 2012 Apr
TI  - [Immune reconstitution inflammatory syndrome in cryptococcal meningitis: a rare 
      phenomenon?].
PG  - 834-7
LID - 10.1055/s-0032-1304867 [doi]
AB  - HISTORY AND ADMISSION FINDINGS: A 38-year old patient with previously untreated 
      HIV infection presented with progressive cephalgia, photophobia, polydpsia and 
      nausea/vomiting. INVESTIGATIONS: Clinical findings revealed a reduced general 
      state of health and focal neurological deficits. Laboratory findings demonstrated 
      a lymphocytopenia. In addition to positive crytococcus culture and antigen titer 
      in cerebrospinal fluid/serum, Cryptococcus neoformans was detected by light 
      microscopy (India ink stain) in cerebrospinal fluid. DIAGNOSIS, TREATMENT AND 
      COURSE: A cryptococcal meningitis was diagnosed. After initiating antifungal and 
      antiretroviral treatment the clinical course worsened after months 2, 3, and 5, 
      respectively. Apart from unspecific inflammation in the lab work, no signs of 
      disease relapse or therapy refractory course were found in additional 
      diagnostics. After critical evaluation of the clinical course and diagnostic 
      results, immune reconstitution inflammatory syndrome (IRIS) was diagnosed. 
      Clinical improvement was achieved during adjuvant treatment with steroids within 
      six months. CONCLUSIONS: In the presence of neurological symptoms, cryptococcal 
      meningitis is a rare but possible differential diagnosis in daily routine. 
      Diagnosis can be easily achieved by India ink stain in combination with culture 
      of cerebrospinal fluid as well as antigen detection in most cases. Tests of 
      antifungal resistance should be reserved for patients who do not respond to 
      initial treatment, patients with atypical course of disease or failing longterm 
      antifungal therapy. The IRIS is no rare complication after initiation of 
      antiretroviral treatment in HIV associated cryptococcal infections. It is an 
      important differential diagnosis in an atypical course of disease, and sufficient 
      treatment is usually achieved by steroids.
CI  - (c) Georg Thieme Verlag KG Stuttgart . New York.
FAU - Schulze, K
AU  - Schulze K
AD  - Sektion Infektiologie und Tropenmedizin, I. Medizinische Klinik und Poliklinik, 
      Universitatsklinikum Hamburg-Eppendorf. kschulze@uke.de
FAU - Schmiedel, S
AU  - Schmiedel S
FAU - van Lunzen, J
AU  - van Lunzen J
LA  - ger
PT  - Case Reports
PT  - English Abstract
PT  - Journal Article
TT  - Immunrekonstitutions- und Inflammationssyndrom bei Kryptokokkose - eine 
      Seltenheit?
DEP - 20120411
PL  - Germany
TA  - Dtsch Med Wochenschr
JT  - Deutsche medizinische Wochenschrift (1946)
JID - 0006723
SB  - IM
MH  - Adult
MH  - Diagnosis, Differential
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/*complications/*diagnosis/therapy
MH  - Male
MH  - Meningitis, Cryptococcal/*complications/*diagnosis/therapy
MH  - Rare Diseases/complications/diagnosis/therapy
EDAT- 2012/04/13 06:00
MHDA- 2012/05/30 06:00
CRDT- 2012/04/13 06:00
PHST- 2012/04/13 06:00 [entrez]
PHST- 2012/04/13 06:00 [pubmed]
PHST- 2012/05/30 06:00 [medline]
AID - 10.1055/s-0032-1304867 [doi]
PST - ppublish
SO  - Dtsch Med Wochenschr. 2012 Apr;137(16):834-7. doi: 10.1055/s-0032-1304867. Epub 
      2012 Apr 11.