Cervical lymphadenitis caused by Cryptococcus-related immune reconstitutional inflammatory syndrome

Tsai, Hung-Chin; Lee, S. S.-J.; Wann, Shue Ren; Chen, Y.-S.

doi:10.1093/qjmed/hcp134

Cited by 6 publications

(2 citation statements)

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“…Fungal pathogens associated with CNS-IRIS include Cryptococcus neoformans and Candida, most often presenting as meningitis, intracranial cryptococcoma and cervical lymphadenitis [24][25][26]. Cryptococcus IRIS is mainly mediated by CD4 þ T cells and macrophages, whereas Candida IRIS involves CD8 þ T cells [24,26].…”

Section: Key Pointsmentioning

confidence: 99%

Immune reconstitution inflammatory syndrome and the central nervous system

Johnson

Nath

2011

Current Opinion in Neurology

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The risk for CNS-IRIS can be decreased by starting ART early in the course of the illness or by reducing antigenic burden with antimicrobial treatment for opportunistic infections prior to starting ART. Of all the forms of CNS-IRIS, the management of IRIS associated with PML due to JC virus infection remains the most challenging, as no antimicrobial drug against this virus is available and the treatment of IRIS requires the use of corticosteroids, which impair the immune cells needed to control the infection.

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Section: Key Pointsmentioning

confidence: 99%

Immune reconstitution inflammatory syndrome and the central nervous system

Johnson

Nath

2011

Current Opinion in Neurology

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“…It commonly presents as recurrent meningitis. Lymphadenitis is considered a rare event with only a few cases reported in the literature [ 4 , 5 ]. We believe our patient developed cryptococcal IRIS manifesting as lymphadenitis.…”

mentioning

confidence: 99%

Cryptococcal Lymphadenitis in an HIV-Infected Patient: A Rare Manifestation of Immune Reconstitution Inflammatory Syndrome

Zamora

Varadarajalu

2018

Diseases

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Cryptococcosis is a fungal infection that is typically associated with acquired immunodeficiency syndrome (AIDS). The advent of highly active antiretroviral therapy has decreased the frequency of this infection, but has led to the emergence of atypical cases of immune reconstitution inflammatory syndrome (IRIS). Here, we describe the case of a 40-year-old man who was diagnosed with HIV infection and cryptococcal meningitis. He was successfully treated with antifungals and then started antiretroviral therapy. The patient returned to the hospital 15 months later complaining of fever, pain, and neck swelling. A computed tomography (CT) scan revealed a conglomerate of necrotic lymph nodes in the supraclavicular region. He underwent biopsy and histology showed granulomatous inflammation with fungal elements, consistent with Cryptococcus. He tested positive for serum cryptococcal antigen. The patient was treated with liposomal amphotericin and flucytosine. After induction therapy, he was re-started on fluconazole. The final fungal cultures were negative. We attributed our patient’s clinical presentation to “paradoxical” IRIS, which was associated with his previously treated cryptococcosis. Near resolution of the supraclavicular mass was noted at the 3-month follow-up.

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