We report a case of a symptomatic relapse of HIV-related cryptococcal meningoencephalitis eight years after the first diagnosis on the background of immune reconstitution. The findings as well as the clinical course suggests a combination of smouldering localised infection and enhanced inflammatory reaction related to immune restoration due to antiretroviral therapy. A combination of antifungal and anti-inflammatory therapy resulted in clinical and radiological improvement. Our case challenges the concept that immune reconstitution inflammatory syndrome and microbiological relapse are dichotomous entities.
MusubireAKBoulwareDRMeyaDB. Diagnosis and management of cryptococcal relapse. J AIDS Clin Res2013; pii: S3–003.
2.
HaddowLJColebundersRMeintjesG. International network for the study of HIV-associated IRIS (INSHI). Cryptococcal immune reconstitution inflammatory syndrome in HIV-1-infected individuals: proposed clinical case definitions. Lancet Infect Dis2010; 10: 791–802.
3.
BoulwareDRMeyaDBBergemannTL. Clinical features and serum biomarkers in HIV immune reconstitution inflammatory syndrome after Cryptococcal meningitis: a prospective cohort study. PLoS Med2010; 7: e1000384–e1000384.
