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Cryptococcal lymphadenitis as a manifestation of immune reconstitution inflammatory syndrome in an HIV-positive patient: a case report and review of the literature.

Abstract
Cryptococcus neoformans infections are typically associated with T-cell deficiencies, including acquired immunodeficiency syndrome (AIDS). Although highly active antiretroviral therapy (HAART) has strongly reduced AIDS-related opportunistic infections, the restoration and reactivation of CD4+ cells can induce an immune reconstitution inflammatory syndrome (IRIS), consisting in a deregulated inflammatory response to latent infectious pathogens and/or to their residual antigens. Cryptococcal lymphadenitis has occasionally been documented in IRIS. Here we report a case of histology- and culture-negative cryptococcal lymphadenitis associated with IRIS in an adult AIDS patient with a history of disseminated cryptococcosis, after the start of fully adherent HAART. Appropriate diagnosis was established on nested-PCR and sequence analysis of the interspacer region 2 of C. neoformans ribosomal DNA, and detection of slow-growing blastospores in enrichment cultures of fine-needle lymph node aspirate. Review of recent literature and our case findings suggest that IRIS-associated cryptococcal lymphadenitis is more likely the flare up of a latent infection rather than an immunopathological response to residual antigen of unviable cryptococci.
AuthorsL Putignani, G Antonucci, M G Paglia, L Vincenzi, A Festa, P De Mori, L Loiacono, P Visca
JournalInternational journal of immunopathology and pharmacology (Int J Immunopathol Pharmacol) 2008 Jul-Sep Vol. 21 Issue 3 Pg. 751-6 ISSN: 0394-6320 [Print] England
PMID18831914 (Publication Type: Case Reports, Letter, Research Support, Non-U.S. Gov't, Review)
Topics
  • AIDS-Related Opportunistic Infections (etiology)
  • Adult
  • Cryptococcosis (etiology)
  • HIV Seropositivity (complications)
  • Humans
  • Inflammation (complications)
  • Lymphadenitis (etiology)
  • Male
  • Syndrome

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