PMID- 37772202
OWN - NLM
STAT- Publisher
LR  - 20230930
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 15
IP  - 8
DP  - 2023 Aug
TI  - When the Cure Becomes the Problem: A Case Report of Immune Reconstitution 
      Inflammatory Syndrome Associated With Varicella Encephalitis.
PG  - e44223
LID - 10.7759/cureus.44223 [doi]
LID - e44223
AB  - Immune reconstitution inflammatory syndrome (IRIS) describes a constellation of 
      inflammatory symptoms that develop following the initiation of antiretroviral 
      therapy (ART) in patients with advanced human immunodeficiency virus (HIV). Here, 
      we present a case of a 39-year-old male-to-female transgender patient with 
      advanced HIV who was started on ART during a hospitalization for acute 
      encephalopathy due to a combination of methicillin-resistant Staphylococcus 
      aureus (MRSA) meningitis and varicella encephalitis. After adequate treatment of 
      these infections and five weeks after initiation of ART, she developed 
      inflammatory symptoms of malaise, fever, and tachycardia, as well as laboratory 
      findings of leukocytosis consistent with an inflammatory process. Infectious 
      workup did not reveal any evidence of a new infection, and no other undiagnosed 
      inflammatory processes were discovered to explain these symptoms. A diagnosis of 
      IRIS was suspected, possibly induced by a prior varicella infection. Diagnosis of 
      IRIS can be difficult due to heterogeneous symptoms, differing etiologies, 
      variable patient presentations, and the lack of universal diagnostic criteria. As 
      instances of IRIS are not uncommon in patients with a low CD4 count who start on 
      ART, there should be a high index of suspicion when patients present with 
      inflammatory symptoms after initiation of ART. With increased recognition of the 
      disease and improved standardization of diagnostic criteria, more could be 
      understood about the underlying disease process which may allow for better 
      targeted therapies and individualized treatments for patients who develop the 
      immune reconstitution inflammatory syndrome.
CI  - Copyright (c) 2023, Lin et al.
FAU - Lin, Kuan-Yu
AU  - Lin KY
AD  - Medical School, Saint Louis University School of Medicine, St. Louis, USA.
FAU - Streicher, Adam
AU  - Streicher A
AD  - Internal Medicine, SSM Health Saint Louis University Hospital, St. Louis, USA.
FAU - Wheeler, Joseph
AU  - Wheeler J
AD  - Internal Medicine, SSM Health Saint Louis University Hospital, St. Louis, USA.
LA  - eng
PT  - Case Reports
DEP - 20230827
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC10531033
OTO - NOTNLM
OT  - antiretroviral therapies
OT  - hiv aids
OT  - immune reconstitution syndrome
OT  - infectious disease medicine
OT  - varicella encephalitis
COIS- The authors have declared that no competing interests exist.
EDAT- 2023/09/29 06:43
MHDA- 2023/09/29 06:43
PMCR- 2023/08/27
CRDT- 2023/09/29 04:04
PHST- 2023/08/26 00:00 [accepted]
PHST- 2023/09/29 06:43 [medline]
PHST- 2023/09/29 06:43 [pubmed]
PHST- 2023/09/29 04:04 [entrez]
PHST- 2023/08/27 00:00 [pmc-release]
AID - 10.7759/cureus.44223 [doi]
PST - epublish
SO  - Cureus. 2023 Aug 27;15(8):e44223. doi: 10.7759/cureus.44223. eCollection 2023 
      Aug.