PMID- 36268454
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20221022
IS  - 2049-0801 (Print)
IS  - 2049-0801 (Electronic)
IS  - 2049-0801 (Linking)
VI  - 82
DP  - 2022 Oct
TI  - Too much of a good thing: Immune reconstitution inflammatory syndrome in a 
      patient with Still's disease.
PG  - 104590
LID - 10.1016/j.amsu.2022.104590 [doi]
LID - 104590
AB  - Immune Reconstitution Inflammatory Syndrome (IRIS) is a potential complication 
      when treating non HIV immunosuppressed patients with opportunistic infections. We 
      present a case of a 49-year-old female with Adult-onset Still's disease on 
      prednisone 40 mg daily who came to ED with right leg weakness and intractable 
      headache for one week. She was diagnosed with Cryptococcus meningitis. Patient 
      completed the induction phase of antifungal therapy and the steroids were tapered 
      over four weeks. One month after discharge, a patient was brought in to ED, 
      minimally responsive to verbal stimuli and had new left hemiparesis with 
      persistent right leg weakness was noted on exam. An MRI of the brain was 
      consistent with diffuse leptomeningeal enhancement compatible with 
      meningoencephalitis. LP was notable for elevated opening pressure of 36cmH2O and 
      CSF studies were negative for recurrence of cryptococcal infection. Given the 
      timeline of patients presentation one month after discontinuation of steroids, 
      and workup consistent with sterile meningitis, immune reconstitution inflammatory 
      syndrome was identified as the likely diagnosis. The patient was started on 50 mg 
      of Prednisone daily. Six weeks after presentation, the patient's mental status 
      returned to baseline, left hemiparesis resolved, and right lower extremity 
      strength significantly improved. Clinicians should have a high index of suspicion 
      for CNS IRIS in patients presenting with new neurologic findings in the setting 
      of rapid discontinuation of steroids due to infection. IRIS in HIV patients with 
      cryptococcal meningitis is a well-established entity; the purpose of this case 
      report is to bring attention to similar inflammatory syndrome in non-HIV patients 
      with cryptococcal meningitis.
CI  - (c) 2022 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.
FAU - Batool, Nuzhat
AU  - Batool N
AD  - Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Elmhurst 
      Hospital, NY, USA.
FAU - Song, David
AU  - Song D
AD  - Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Elmhurst 
      Hospital, NY, USA.
FAU - Almas, Talal
AU  - Almas T
AD  - Royal College of Surgeons in Ireland, Dublin, Ireland.
FAU - Alsubai, Abdulla K
AU  - Alsubai AK
AD  - Royal College of Surgeons in Ireland, Dublin, Ireland.
FAU - Thakur, Tushar
AU  - Thakur T
AD  - National University of Ireland, Galway, Ireland.
FAU - Ismail, Hebatalla
AU  - Ismail H
AD  - Royal College of Surgeons in Ireland, Dublin, Ireland.
FAU - Alsufyani, Majid
AU  - Alsufyani M
AD  - Royal College of Surgeons in Ireland, Dublin, Ireland.
FAU - Hadeed, Sebastian
AU  - Hadeed S
AD  - Royal College of Surgeons in Ireland, Dublin, Ireland.
FAU - Huang, Helen
AU  - Huang H
AD  - Royal College of Surgeons in Ireland, Dublin, Ireland.
FAU - Kotait, Farida
AU  - Kotait F
AD  - Royal College of Surgeons in Ireland, Dublin, Ireland.
FAU - Aldhaheri, Khaled Saeed Obaid
AU  - Aldhaheri KSO
AD  - Royal College of Surgeons in Ireland, Dublin, Ireland.
FAU - Sindi, Atif Bakr
AU  - Sindi AB
AD  - Royal College of Surgeons in Ireland, Dublin, Ireland.
FAU - Chan, Emilie
AU  - Chan E
AD  - Department of Rheumatology, Icahn School of Medicine at Mount Sinai, USA.
FAU - Salama, Carlos
AU  - Salama C
AD  - Department of Infectious Disease, Icahn School of Medicine at Mount Sinai, USA.
LA  - eng
PT  - Journal Article
DEP - 20220913
PL  - England
TA  - Ann Med Surg (Lond)
JT  - Annals of medicine and surgery (2012)
JID - 101616869
PMC - PMC9577525
EDAT- 2022/10/22 06:00
MHDA- 2022/10/22 06:01
PMCR- 2022/09/13
CRDT- 2022/10/21 03:13
PHST- 2022/07/14 00:00 [received]
PHST- 2022/09/01 00:00 [revised]
PHST- 2022/09/04 00:00 [accepted]
PHST- 2022/10/21 03:13 [entrez]
PHST- 2022/10/22 06:00 [pubmed]
PHST- 2022/10/22 06:01 [medline]
PHST- 2022/09/13 00:00 [pmc-release]
AID - S2049-0801(22)01350-4 [pii]
AID - 104590 [pii]
AID - 10.1016/j.amsu.2022.104590 [doi]
PST - epublish
SO  - Ann Med Surg (Lond). 2022 Sep 13;82:104590. doi: 10.1016/j.amsu.2022.104590. 
      eCollection 2022 Oct.