An Immune Reconstitution Syndrome-Like Illness Associated withCryptococcus neoformans Infection in Organ Transplant Recipients

Abstract

This study demonstrated that an IRS-like entity occurs in organ transplant recipients with C. neoformans infection. Furthermore, this entity may be misconstrued as a failure of therapy. Immunomodulatory agents may have a role as adjunctive therapy in such cases.

Cellulitis Revealing a Cryptococcosis-Related Immune Reconstitution Inflammatory Syndrome in a Renal Allograft Recipient

“…Clinical manifestations associated with C. neoformans IRIS may consist in worsening of neurological symptoms, and myositis in solid-organ transplanted patients (6). Of note, cellulitis with necrotic adenitis as a manifestation of cryptococcosisrelated IRIS has already been reported in the setting of AIDS (5).…”

“…The absence of positive fungal culture, worsening condition after antifungal therapy and broad-spectrum antibiotherapy and improvement with corticosteroids are consistent with IRIS, but not with microbiologically active fungal or bacterial infection. It has been suggested that antifungal therapy and IS withdrawal reverse the Th2-predominant immune profile induced by the fungus in combination with the IS therapy towards a Th1/pro-inflammatory leading to the overwhelming granulomatous reaction defining IRIS (6).…”

Fungal Infections in Transplant and Oncology Patients

“…As noted, rapid reduction of immunosuppressive therapy in conjunction with initiation of antifungal therapy in SOT recipients may lead to the development of IRIS, the clinical manifestations of which mimic worsening disease [118]. Reversal of neutropenia is another oft-used strategy in managing IFIs.…”

Novel immune regulatory pathways and their role in immune reconstitution syndrome in organ transplant recipients with invasive mycoses

“…IRS in invasive fungal infections such as cryptococcosis and histoplasmosis typically presents as lymphadenitis, enhancing central nervous system lesions, and skin or soft tissue masses [1,[59][60][61]. In a subset of patients with Pneumocystis jiroveci pneumonia and invasive pulmonary aspergillosis, worsening or symptomatic disease during receipt of appropriate therapy is also considered to be due to IRS [1,62,63].…”