HIV-RELATED IMMUNE RECONSTITUTION CRYPTOCOCCAL MENINGORADICULITIS: CORTICOSTEROID RESPONSE

Abstract

Cryptococcosis is the most common life-threatening opportunistic fungal infection in patients with AIDS; meningitis and meningoencephalitis are the most frequent manifestations. Meningoradicular involvement is exceptional. We report a case of meningoradiculitis due to Cryptococcus appearing after several weeks of antiretroviral and antifungal treatments, managed by corticosteroids, and which was suggestive of immune reconstitution inflammatory syndrome (IRIS). ### Case report. A 32-year-old HIV-infected man presented with a 7-day history of intense headache and vomiting. On admission, he was afebrile and examination was normal (no radicular symptoms). Evaluation of CSF showed no white cells, a moderately elevated total protein (490 mg/L), and normal glucose levels (3 mmol/L). The intracranial pressure was 34 cm H2O. Smear and cultures for bacteria and acid-fast bacilli were negative. An India ink preparation of the CSF revealed encapsulated yeast-like fungi, and Cryptococcus neoformans variety grubii was isolated. The C neoformans antigen latex agglutination test showed elevated titers in both serum (1:16,000) and CSF (1:8,000). The CD4 cell count was 97/μL and viral load was 454 copies/mL. Treatment including IV liposomal amphotericin B (3 mg/kg per day) and flucytosine (100 mg/kg per day) was started, associated with external lumbar derivation for severe intracranial pressure. Highly active antiretroviral therapy was begun 2 weeks after antifungal treatment (abacavir/lamivudine with lopinavir/ritonavir). However, the patient’s consciousness level progressively deteriorated, the trachea was intubated, and he was transferred to the intensive …