Cryptococcal Lymphadenitis as a Manifestation of Immune Reconstitution Inflammatory Syndrome in an HIV-Positive Patient: A Case Report and Review of the Literature

Cryptococcus neoformans infections are typically associated with T-cell deficiencies, including acquired immunodeficiency syndrome (AIDS). Although highly active antiretroviral therapy (HAART) has strongly reduced AIDS-related opportunistic infections, the restoration and reactivation of CD4+ cells...

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Bibliographic Details
Published in:International journal of immunopathology and pharmacology 2008-07, Vol.21 (3), p.751-756
Main Authors: Putignani, L., Antonucci, G., Paglia, M.G., Vincenzi, L., Festa, A., De Mori, P., Loiacono, L., Visca, P.
Format: Article
Language:English
Subjects:
Adult
AIDS-Related Opportunistic Infections - etiology
Cryptococcosis - etiology
HIV Seropositivity - complications
Humans
Inflammation - complications
Lymphadenitis - etiology
Male
Syndrome
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Summary:Cryptococcus neoformans infections are typically associated with T-cell deficiencies, including acquired immunodeficiency syndrome (AIDS). Although highly active antiretroviral therapy (HAART) has strongly reduced AIDS-related opportunistic infections, the restoration and reactivation of CD4+ cells can induce an immune reconstitution inflammatory syndrome (IRIS), consisting in a deregulated inflammatory response to latent infectious pathogens and/or to their residual antigens. Cryptococcal lymphadenitis has occasionally been documented in IRIS. Here we report a case of histology- and culture-negative cryptococcal lymphadenitis associated with IRIS in an adult AIDS patient with a history of disseminated cryptococcosis, after the start of fully adherent HAART. Appropriate diagnosis was established on nested-PCR and sequence analysis of the interspacer region 2 of C. neoformans ribosomal DNA, and detection of slow-growing blastospores in enrichment cultures of fine-needle lymph node aspirate. Review of recent literature and our case findings suggest that IRIS-associated cryptococcal lymphadenitis is more likely the flare up of a latent infection rather than an immunopathological response to residual antigen of unviable cryptococci.
ISSN:0394-6320
2058-7384
DOI:10.1177/039463200802100332