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African Health Sciences
Makerere University Medical School
ISSN: 1680-6905
EISSN: 1680-6905
Vol. 12, No. 2, 2012, pp. 226-230
Bioline Code: hs12038
Full paper language: English
Document type: Research Article
Document available free of charge

African Health Sciences, Vol. 12, No. 2, 2012, pp. 226-230

 en Challenges in diagnosis and management of Cryptococcal immune reconstitution inflammatory syndrome (IRIS) in resource limited settings
Musubire, A.K.; Meya, B.D.; Mayanja-Kizza, H.; Lukande, R.; Wiesner, L.D.; Bohjanen, P.R. & Boulware, R.D.


In many resource-limited settings, cryptococcal meningitis (CM) contributes up to 20% of all deaths with further complications due to Immune Reconstitution Inflammatory Syndrome (IRIS). We present a case report on a patient who developed CMIRIS and then subsequent CM-relapse with a fluconazole-resistant organism and then later CM-IRIS once again, manifesting as cystic cryptococcomas, hydrocephalus, and sterile CSF. In this case we, demonstrate that CM-IRIS and persistent low level cryptococcal infection are not mutually exclusive phenomena. The management of IRIS with corticosteroids may increase the risk of culture positive CM-relapse which may further increase the risk of recurrent IRIS and resulting complications including death. We also highlight the role of imaging and fluconazole resistance testing in patients with recurrent meningitis and the importance of CSF cultures in guiding treatment decisions.

HIV, AIDS, Cryptococcal Meningitis, antiretroviral therapy, Immune reconstitution inflammatory Syndrome

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