Immune reconstitution inflammatory syndrome involving the central nervous system in a patient with HIV infection: a case report and review of literature

IRIS is described as a paradoxical deterioration of clinical status upon initiation of combined anti-retroviral therapy (cART) in patients with HIV infection. Immune reconstitution inflammatory syndrome (CNS-IRIS) involving the central nervous system is rarely reported. We describe the case of 57-ye...

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Bibliographic Details
Published in:The New microbiologica 2013-01, Vol.36 (1), p.89-92
Main Authors: Zaffiri, Lorenzo, Verma, Rajanshu, Struzzieri, Kevin, Monterroso, Joanne, Batts, Donald H, Loehrke, Mark E
Format: Article
Language:English
Subjects:
AIDS-Related Opportunistic Infections - complications
AIDS-Related Opportunistic Infections - drug therapy
AIDS-Related Opportunistic Infections - pathology
Antiretroviral Therapy, Highly Active - adverse effects
Brain - pathology
Bronchoalveolar Lavage Fluid - microbiology
CD4 Lymphocyte Count
CD4-Positive T-Lymphocytes
Central Nervous System Diseases - drug therapy
Central Nervous System Diseases - etiology
Central Nervous System Diseases - pathology
Drug Therapy, Combination
HIV Infections - complications
HIV Infections - drug therapy
HIV Infections - immunology
HIV-1
Humans
Immune Reconstitution Inflammatory Syndrome - complications
Immune Reconstitution Inflammatory Syndrome - diagnosis
Immune Reconstitution Inflammatory Syndrome - drug therapy
Magnetic Resonance Imaging
Male
Middle Aged
Pneumocystis carinii - isolation & purification
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Summary:IRIS is described as a paradoxical deterioration of clinical status upon initiation of combined anti-retroviral therapy (cART) in patients with HIV infection. Immune reconstitution inflammatory syndrome (CNS-IRIS) involving the central nervous system is rarely reported. We describe the case of 57-year-old man who developed a fatal case of CNS- IRIS. A rapid deterioration of neurological status was associated with progression of patchy T2-weighted hyperintensities involving different vascular territories on brain MRI. Diagnosis of CNS-IRIS is based of laboratory and radiologic findings, however brain biopsy is supportive. Despite immune restoration being involved in clinical deterioration, discontinuation of cART is not recommended. The use of corticosteroids is highly controversial. Prompt recognition of CNS-IRIS is crucial for preventing neurological complications and ensuing sequelae.
ISSN:1121-7138