PMID- 36384196
OWN - NLM
STAT- MEDLINE
DCOM- 20230130
LR  - 20230202
IS  - 1437-7780 (Electronic)
IS  - 1341-321X (Linking)
VI  - 29
IP  - 3
DP  - 2023 Mar
TI  - Cryptococcal meningitis with atypical paradoxical inflammatory reactions after 
      antifungal treatment in acquired immune deficiency syndrome: A case report.
PG  - 347-352
LID - S1341-321X(22)00305-1 [pii]
LID - 10.1016/j.jiac.2022.11.002 [doi]
AB  - Cryptococcal meningitis (CM) is a life-threatening disease that primarily affects 
      patients with human immunodeficiency virus (HIV). Antifungal therapy with 
      antiretroviral treatment (ART) usually leads to the clinical remission of CM; 
      however, in some cases, these treatments exacerbate intracranial inflammation 
      because of paradoxical inflammatory reaction or immune reconstitution 
      inflammatory syndrome (IRIS). Here we report two CM cases that presented atypical 
      clinical courses attributed to paradoxical inflammatory reactions. The first case 
      was a 43-year-old man with headache and vertigo diagnosed with CM and HIV. The 
      patient's CM not only was refractory to the antifungal combination therapy of 
      liposomal amphotericin B (L-AMB) and fluconazole (FLCZ) but suddenly worsened 
      because of a paradoxical inflammatory reaction after 18 days of treatment. He 
      passed away from brain herniation on day 23. The second case was a 43-year-old 
      man diagnosed with CM and HIV. After receiving antifungal therapy and ART, the 
      patient's status was stable for more than 3 years with undetectable HIV-RNA. He 
      suddenly presented with brain inflammation and was diagnosed with IRIS due to CM 
      (CM-IRIS). His brain lesions were migratory and refractory to various antifungal 
      therapies such as L-AMB, FLCZ, flucytosine, and intrathecal amphotericin B. 
      Although the cryptococcal antigen in the patient's cerebrospinal fluid gradually 
      diminished after continuous antifungal therapies, his cognitive function 
      declined, and right hemiparesis persisted. These two cases of CM presented 
      atypical clinical courses, presumably because of paradoxical inflammatory 
      reactions. It should be noted that the onset of CM-IRIS may not necessarily 
      depend on the timing of ART initiation.
CI  - Copyright (c) 2022 Japanese Society of Chemotherapy and The Japanese Association 
      for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
FAU - Samukawa, Sei
AU  - Samukawa S
AD  - Department of Stem Cell and Immune Regulation, Yokohama City University Graduate 
      School of Medicine, Yokohama, 236-0004, Japan.
FAU - Yoshimi, Ryusuke
AU  - Yoshimi R
AD  - Department of Stem Cell and Immune Regulation, Yokohama City University Graduate 
      School of Medicine, Yokohama, 236-0004, Japan. Electronic address: 
      yoshiryu@med.yokohama-cu.ac.jp.
FAU - Kojitani, Noriko
AU  - Kojitani N
AD  - Department of Stem Cell and Immune Regulation, Yokohama City University Graduate 
      School of Medicine, Yokohama, 236-0004, Japan.
FAU - Uzawa, Yuji
AU  - Uzawa Y
AD  - Department of Stem Cell and Immune Regulation, Yokohama City University Graduate 
      School of Medicine, Yokohama, 236-0004, Japan.
FAU - Takase-Minegishi, Kaoru
AU  - Takase-Minegishi K
AD  - Department of Stem Cell and Immune Regulation, Yokohama City University Graduate 
      School of Medicine, Yokohama, 236-0004, Japan.
FAU - Kirino, Yohei
AU  - Kirino Y
AD  - Department of Stem Cell and Immune Regulation, Yokohama City University Graduate 
      School of Medicine, Yokohama, 236-0004, Japan.
FAU - Soejima, Yutaro
AU  - Soejima Y
AD  - Department of Stem Cell and Immune Regulation, Yokohama City University Graduate 
      School of Medicine, Yokohama, 236-0004, Japan.
FAU - Kato, Hideaki
AU  - Kato H
AD  - Department of Stem Cell and Immune Regulation, Yokohama City University Graduate 
      School of Medicine, Yokohama, 236-0004, Japan.
FAU - Nakajima, Hideaki
AU  - Nakajima H
AD  - Department of Stem Cell and Immune Regulation, Yokohama City University Graduate 
      School of Medicine, Yokohama, 236-0004, Japan.
LA  - eng
PT  - Case Reports
DEP - 20221113
PL  - Netherlands
TA  - J Infect Chemother
JT  - Journal of infection and chemotherapy : official journal of the Japan Society of 
      Chemotherapy
JID - 9608375
RN  - 0 (Antifungal Agents)
RN  - 0 (liposomal amphotericin B)
RN  - 8VZV102JFY (Fluconazole)
RN  - 0 (Anti-Retroviral Agents)
SB  - IM
MH  - Male
MH  - Humans
MH  - Adult
MH  - Antifungal Agents/adverse effects
MH  - *Meningitis, Cryptococcal/drug therapy/diagnosis
MH  - *Acquired Immunodeficiency Syndrome/complications/drug therapy
MH  - *AIDS-Related Opportunistic Infections/drug therapy
MH  - Fluconazole/adverse effects
MH  - *HIV Infections/complications/drug therapy
MH  - Anti-Retroviral Agents/therapeutic use
MH  - Inflammation/drug therapy
MH  - HIV
MH  - *Immune Reconstitution Inflammatory Syndrome/drug therapy
OTO - NOTNLM
OT  - Acquired immune deficiency syndrome (AIDS)
OT  - Antiretroviral therapy (ART)
OT  - Cryptococcal meningitis (CM)
OT  - HIV
OT  - Immune reconstitution inflammatory syndrome (IRIS)
COIS- Declaration of competing interest The authors declare that they have no competing 
      interests.
EDAT- 2022/11/18 06:00
MHDA- 2023/01/31 06:00
CRDT- 2022/11/17 09:30
PHST- 2022/08/15 00:00 [received]
PHST- 2022/10/24 00:00 [revised]
PHST- 2022/11/07 00:00 [accepted]
PHST- 2022/11/18 06:00 [pubmed]
PHST- 2023/01/31 06:00 [medline]
PHST- 2022/11/17 09:30 [entrez]
AID - S1341-321X(22)00305-1 [pii]
AID - 10.1016/j.jiac.2022.11.002 [doi]
PST - ppublish
SO  - J Infect Chemother. 2023 Mar;29(3):347-352. doi: 10.1016/j.jiac.2022.11.002. Epub 
      2022 Nov 13.