Journal Article

Immune Reconstitution Cryptococcosis after Initiation of Successful Highly Active Antiretroviral Therapy

Elizabeth R. Jenny Avital and Maria Abadi

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 35, issue 12, pages e128-e133
Published in print December 2002 | ISSN: 1058-4838
Published online December 2002 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/344467
Immune Reconstitution Cryptococcosis after Initiation of Successful Highly Active Antiretroviral Therapy

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Five of 10 patients who commenced successful highly active antiretroviral therapy (HAART) for infection with human immunodeficiency virus type 1 (HIV-1) concurrent with or soon after a diagnosis of cryptococcal infection experienced clinical events characterized by sterile inflammation. Two patients developed aseptic meningitis with elevated intracranial pressure, 1 developed intrathoracic lyphadenopathy with hypercalcemia, 1 developed cavitary pneumonia at the site of a cryptococcal nodule, and 1 developed a supraclavicular abscess. These events occurred 2–11 months after initiation of HAART. For 3 patients, biopsy demonstrated findings atypical for acquired immunodeficiency syndrome—associated cryptococcosis. Results of fungal cultures were negative for all 5 patients, and cryptococcal antigen levels had declined markedly in 4 patients. The timing and clinical features of and biopsy findings for these cases of cryptococcosis suggest the existence of a paradoxical reaction to Cryptococcus infection that occurs in the context of HIV immune restoration.

Journal Article.  3207 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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