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J Int Assoc Provid AIDS Care. 2017 Nov/Dec;16(6):540-545. doi: 10.1177/2325957417729751. Epub 2017 Sep 14.

Immune Reconstitution Inflammatory Syndrome in Patients with AIDS and Disseminated Coccidioidomycosis: A Case Series and Review of the Literature.

Author information

1
1 Division of Infectious Diseases, University of California San Francisco, Fresno Medical Education Program, Fresno, CA, USA.
2
2 Department of Medicine, University of California San Francisco, Fresno Medical Education Program, Fresno, CA, USA.

Abstract

Coccidioidomycosis causes substantial morbidity and mortality in endemic areas, and dissemination is frequent in patients with impaired cellular immunity such as AIDS. Immune reconstitution inflammatory syndrome (IRIS) is paradoxical clinical worsening after initiation of antiretroviral therapy (ART) in a patient with HIV and a simultaneous opportunistic infection (OI). Immune reconstitution inflammatory syndrome has been well described for a host of mycobacterial, viral, and fungal OIs and malignancies such as Kaposi sarcoma. To date, only 3 cases of IRIS due to coccidioidomycosis have been reported in the literature. At our institution, we report 4 cases of IRIS in HIV-infected patients with disseminated coccidioidomycosis. Unfortunately, all 4 patients died of worsening coccidioidal infection after initiating ART. The optimal timing of ART in patients with AIDS and coccidioidomycosis remains to be elucidated.

KEYWORDS:

HIV/AIDS; antiretroviral therapy; coccidioidomycosis; immune reconstitution inflammatory syndrome

PMID:
28911256
DOI:
10.1177/2325957417729751
[Indexed for MEDLINE]

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