Paradoxical immune reconstitution inflammatory syndrome due to toxoplasmic encephalitis: two cases and review of initiation of antiretroviral timing in toxoplasmic encephalitis IRIS [version 1; peer review: 3 approved]

Toxoplasma encephalitis immune reconstitution inflammatory syndrome (TE-IRIS) is rare and usually occurs in an unmasking, rather than paradoxical form. To the best of our knowledge, only two cases of paradoxical TE-IRIS and nine cases of unmasking TE-IRIS have been previously described. We present t...

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Bibliographic Details
Published in:F1000 research 2013, Vol.2, p.133-133
Main Authors: DiNardo, Andrew R, Lewis, Douglas Smoot, Koo, Hoonmo L, Goodman, J Clay, Chiao, Elizabeth, Andrade, Roberto
Format: Article
Language:English
Subjects:
Clinical Practice
HIV Infection & AIDS: Clinical
Immune & Inflammatory Rheumatic Diseases (incl. Arthritis)
Infectious Diseases of the Nervous System
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Summary:Toxoplasma encephalitis immune reconstitution inflammatory syndrome (TE-IRIS) is rare and usually occurs in an unmasking, rather than paradoxical form. To the best of our knowledge, only two cases of paradoxical TE-IRIS and nine cases of unmasking TE-IRIS have been previously described. We present two additional cases of histopathology-consistent paradoxical TE-IRIS, after early initiation of antiretroviral therapy (ART), and review the literature on TE-IRIS. Three of the four reported cases of paradoxical TE-IRIS were associated with early (within one week) initiation of ART, an issue that was not addressed in the 2009 US Department of Health and Human Services guidelines for the treatment of opportunistic infections.
ISSN:2046-1402
2046-1402
DOI:10.12688/f1000research.2-133.v1