PMID- 38083828
OWN - NLM
STAT- MEDLINE
DCOM- 20231216
LR  - 20231221
IS  - 1941-5923 (Electronic)
IS  - 1941-5923 (Linking)
VI  - 24
DP  - 2023 Dec 12
TI  - Recurrent Cryptococcal Meningitis in a Late Presenter of HIV: A Rare Case Report 
      and Review of Literature.
PG  - e941714
LID - 10.12659/AJCR.941714 [doi]
AB  - BACKGROUND The highly active antiretroviral treatment (HAART) and the primary 
      prophylaxis in newly diagnosed people living with HIV (PLHIV) have reduced the 
      incidence of opportunistic infections such as cryptococcal meningitis (CM). 
      Relapse of CM is associated with increased morbidity and mortality. The aim of 
      the present case presentation is to report the clinical progress relapse of CM in 
      a man who was a late presenter PLHIV, 1 year after ART initiation with increased 
      CD4 cell count, undetectable viral load, and excellent compliance after 
      disruption of secondary antifungal prophylaxis. CASE REPORT One year after 
      initial diagnosis of HIV and CM, the patient had no neurological or other 
      symptoms, and viral suppression and increased CD4 cell count were achieved. After 
      the completion of 12 months of secondary prophylaxis with fluconazole, an episode 
      of partial seizure with secondary generalization occurred, followed by a 
      short-term memory loss. Magnetic resonance imaging (MRI) indicated a focal lesion 
      in right frontal-parietal brain region. Lumbar puncture was conducted and 
      Cryptococcus neoformans non-resistant to fluconazole was isolated. He received 
      antiepileptic treatment, induction antifungal treatment with liposomal 
      amphotericin and fluconazole, consolidation treatment with fluconazole, and 
      secondary prophylaxis with fluconazole, as in the first episode of CM. One year 
      after the relapse, antiepileptic treatment and secondary prophylaxis with 
      fluconazole continues and no new episode has been reported. The diagnosis of 
      immune reconstitution inflammatory syndrome (IRIS)-related relapse of CM cannot 
      be excluded. CONCLUSIONS Further studies are needed for the evaluation of 
      parameters such as duration of secondary prophylaxis and treatment options for 
      induction and consolidation therapy to reduce the relapse rate of CM.
FAU - Petrakis, Vasileios
AU  - Petrakis V
AD  - Department of Infectious Diseases, HIV Unit, University General Hospital of 
      Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.
AD  - 2nd University Department of Internal Medicine, University General Hospital of 
      Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.
FAU - Angelopoulou, Christina G
AU  - Angelopoulou CG
AD  - Department of Neurology, University General Hospital of Alexandroupolis, 
      Democritus University of Thrace, Alexandroupolis, Greece.
FAU - Psatha, Evlampia
AU  - Psatha E
AD  - Department of Radiology, University General Hospital of Alexandroupolis, 
      Democritus University of Thrace, Alexandroupolis, Greece.
FAU - Grapsa, Anastasia
AU  - Grapsa A
AD  - Department of Microbiology, University General Hospital of Alexandroupolis, 
      Democritus University of Thrace, Alexandroupols, Greece.
FAU - Panopoulou, Maria
AU  - Panopoulou M
AD  - Department of Microbiology, University General Hospital of Alexandroupolis, 
      Democritus University of Thrace, Alexandroupols, Greece.
FAU - Papazoglou, Dimitrios
AU  - Papazoglou D
AD  - Department of Infectious Diseases, HIV Unit, University General Hospital of 
      Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.
AD  - 2nd University Department of Internal Medicine, University General Hospital of 
      Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.
FAU - Panagopoulos, Periklis
AU  - Panagopoulos P
AD  - Department of Infectious Diseases, HIV Unit, University General Hospital of 
      Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.
AD  - 2nd University Department of Internal Medicine, University General Hospital of 
      Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Review
DEP - 20231212
PL  - United States
TA  - Am J Case Rep
JT  - The American journal of case reports
JID - 101489566
RN  - 0 (Antifungal Agents)
RN  - 8VZV102JFY (Fluconazole)
RN  - 0 (Anticonvulsants)
SB  - IM
MH  - Male
MH  - Humans
MH  - *Meningitis, Cryptococcal/diagnosis/drug therapy
MH  - Antifungal Agents/therapeutic use
MH  - Fluconazole/therapeutic use
MH  - *AIDS-Related Opportunistic Infections/diagnosis/drug therapy/complications
MH  - Anticonvulsants/therapeutic use
MH  - Neoplasm Recurrence, Local/complications
MH  - Recurrence
MH  - *HIV Infections/complications/drug therapy
PMC - PMC10728884
COIS- Conflict of interest: None declared
EDAT- 2023/12/12 06:42
MHDA- 2023/12/17 09:45
PMCR- 2023/12/12
CRDT- 2023/12/12 01:23
PHST- 2023/12/17 09:45 [medline]
PHST- 2023/12/12 06:42 [pubmed]
PHST- 2023/12/12 01:23 [entrez]
PHST- 2023/12/12 00:00 [pmc-release]
AID - 941714 [pii]
AID - 10.12659/AJCR.941714 [doi]
PST - epublish
SO  - Am J Case Rep. 2023 Dec 12;24:e941714. doi: 10.12659/AJCR.941714.