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Transpl Infect Dis. 2011 Jun;13(3):303-8. doi: 10.1111/j.1399-3062.2010.00592.x. Epub 2010 Dec 16.

Immune reconstitution inflammatory syndrome mimicking relapsing cryptococcal meningitis in a renal transplant recipient.

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  • 1Centre de Néphrologie et Transplantation Rénale, Université de la Méditerranée, Assistance Publique des Hôpitaux de Marseille, Hôpital Conception, Marseille, France. tristan.legris@ap-hm.fr

Abstract

Immune reconstitution inflammatory syndrome (IRIS) is a rare entity that has been described recently in solid organ transplant (SOT) recipients. IRIS is characterized by an exuberant and dysregulated immune response following treatment of opportunistic infections. We describe here the case of a kidney transplant recipient who developed cryptococcal meningitis that was efficiently treated with antifungal therapy and decreased immunosuppression regimen. Eight months later, a paradoxical worsening of neurological symptoms and neuroradiological findings led to the diagnosis of IRIS. A short course of high-dose steroid therapy allowed complete resolution of neurological symptoms. This report highlights the challenge for physicians to distinguish IRIS from a relapsing cryptococcal infection. Clinical improvement of cryptococcosis-associated IRIS by anti-inflammatory drugs needs to be confirmed among SOT recipients.

© 2010 John Wiley & Sons A/S.

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