PMID- 23771547
OWN - NLM
STAT- MEDLINE
DCOM- 20130904
LR  - 20130617
IS  - 1128-3602 (Print)
IS  - 1128-3602 (Linking)
VI  - 17
IP  - 11
DP  - 2013 Jun
TI  - Cryptococcal meningitis in an HIV-1-infected person: relapses or IRIS? Case 
      report and review of the literature.
PG  - 1555-9
LID - 4393 [pii]
AB  - After starting highly active antiretroviral therapy (HAART), HIV-infected 
      patients may experience what is termed immune reconstitution inflammatory 
      syndrome (IRIS). IRIS is characterized by a paradoxical inflammatory response to 
      either previously or recently treated infections or unmasked subclinical 
      infections, when the patient regains the ability to mount a suitable immune 
      response against specific antigens or pathogens. Cryptococcal IRIS (C-IRIS) is 
      thought to be mediated by recovery of Cryptococcus-specific immune responses, 
      resulting in exaggerated host inflammatory responses. In HIV-positive subjects, 
      two distinct modes of presentation of C-IRIS are recognized, "paradoxical" and 
      "unmasking" C-IRIS. "Paradoxical" C-IRIS presents as worsening or recurrence of 
      treated cryptococcal disease following HAART initiation, despite microbiological 
      treatment success. In the "unmasking" form, patients with no prior diagnosis may 
      develop acute symptoms of cryptococcosis, such as meningitis or necrotizing 
      lymphadenopathy, after starting HAART. Here, we present the case of an 
      HIV-positive man, who developed cryptococcal meningitis two months after having 
      started HAART and experienced several meningeal relapses and a "paradoxical" 
      C-IRIS during the following year.
FAU - Nunnari, G
AU  - Nunnari G
AD  - Department of Clinical and Molecular Biomedicine, Division of Infectious 
      Diseases, University of Catania, Garibaldi Nesima Hospital, Catania, Italy.
FAU - Gussio, M
AU  - Gussio M
FAU - Pinzone, M R
AU  - Pinzone MR
FAU - Martellotta, F
AU  - Martellotta F
FAU - Cosentino, S
AU  - Cosentino S
FAU - Cacopardo, B
AU  - Cacopardo B
FAU - Celesia, B M
AU  - Celesia BM
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Review
PL  - Italy
TA  - Eur Rev Med Pharmacol Sci
JT  - European review for medical and pharmacological sciences
JID - 9717360
SB  - IM
MH  - Acquired Immunodeficiency Syndrome/*complications
MH  - Adult
MH  - *HIV-1
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/*etiology
MH  - Male
MH  - Meningitis, Cryptococcal/*etiology
MH  - Recurrence
EDAT- 2013/06/19 06:00
MHDA- 2013/09/05 06:00
CRDT- 2013/06/18 06:00
PHST- 2013/06/18 06:00 [entrez]
PHST- 2013/06/19 06:00 [pubmed]
PHST- 2013/09/05 06:00 [medline]
AID - 4393 [pii]
PST - ppublish
SO  - Eur Rev Med Pharmacol Sci. 2013 Jun;17(11):1555-9.