Paradoxical Cryptococcal Meningitis Immune Reconstitution Inflammatory Syndrome in a Patient with Human Immunodeficiency Virus Infection: Matching Clinical Findings with MRI Findings

Abstract

There are two forms of cryptococcal meningitis immune reconstitution inflammatory syndrome (CM-IRIS): paradoxical CM-IRIS and unmasking CM-IRIS. It is important to distinguish paradoxical CM-IRIS and CM relapse because mortality of CM-IRIS is higher than that of CM without IRIS, and paradoxical CM-IRIS and CM relapse requires different treatment. We report a case of paradoxical CM-IRIS that well matches the clinical findings with MR findings during three years follow-up of a HIV infected patient and new MRI finding is also introduced to help distinguish them.

Keywords

• human immunodeficiency virus
• acquired immune deficiency syndrome
• antiretroviral therapy
• highly active
• cryptococcal meningitis
• immune reconstitution inflammatory syndrome