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Revista Médica del Uruguay

On-line version ISSN 1688-0390

Abstract

QUIAN, Jorge; GUTIERREZ, Stella  and  GONZALEZ, Virginia. Síndrome de reconstitución inmune relacionado con meningitis por Cryptococco en una adolescente infectada con el virus de inmunodeficiencia humana. Rev. Méd. Urug. [online]. 2012, vol.28, n.3, pp.215-220. ISSN 1688-0390.

Summary Immune reconstitution inflammatory syndrome (IRIS) is a complication of HIV (Human Immunodeficiency Virus) in patients who previously had a deep alteration in their immune system. Two forms of clinical presentation are recognized: unmasking and paradoxical IRIS. We present the case of a 13 year old adolescent who is diagnosed with HIV and whose source of infection transmission could not be established. At the time of diagnosis, antiretroviral treatment is initiated under severe immunosuppression, and within two months she is admitted to hospital for a cryptococcal meningitis. Treated with amphotericin, the patient evidences a positive evolution and it was possible to sterilize the spinal fluid. Once again, the patient presents intracranial hypertension with signs of meningeal irritation and seizures. She is transferred to the ICU and treated with high dose corticoids. Upon improvement, the patient is discharged from hospital. The first episode is interpreted as unmasking IRIS cryptococcal meningitis. That is, viable germs stood out in spite of failure to recognize their presence. The second episode is interpreted as a paradoxical IRIS. The fact that it previously had sterile spinal fluid and improved with corticoids and without antifungal treatment confirms diagnosis. Presumed IRIS is diagnosed upon absence of certain diagnostic elements. The clinical data correspond to an immunosuppressed HIV patient, who is treated with high efficacy, what enables diagnosis.

Keywords : IMMUNE RECONSTITUTION INFLAMMATORY SYNDROME; MENINGITIS, CRYPTOCOCCAL; HIV.

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