Paradoxical cryptococcal immune reconstitution inflammatory syndrome in advanced chronic kidney disease

Chih-Chin Kao; Vin-Cent Wu; Hsin-Yun Sun; Che-Hsiung Wu; NSARF Group

doi:10.1007/s11255-012-0196-y

Paradoxical cryptococcal immune reconstitution inflammatory syndrome in advanced chronic kidney disease

Int Urol Nephrol. 2013 Oct;45(5):1505-9. doi: 10.1007/s11255-012-0196-y. Epub 2012 May 25.

Authors

Chih-Chin Kao¹, Vin-Cent Wu, Hsin-Yun Sun, Che-Hsiung Wu; NSARF Group

Affiliation

¹ Division of Nephrology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.

PMID: 22627787
DOI: 10.1007/s11255-012-0196-y

Abstract

Cryptococcal-related immune reconstitution inflammatory syndrome (IRIS) is frequently seen in immunocompromised patients. A 45-year-old man with advanced chronic kidney disease (CKD) received intensive antifungal treatment for pulmonary cryptococcosis. Despite negative pleural effusion cultures and declining serum cryptococcal antigen titers, the patient presented with progressive pulmonary infiltration, intermittent fever, and elevated C-reactive protein. Steroids were given for suspected IRIS, and the clinical condition improved dramatically. This is the first report on paradoxical cryptococcal IRIS in a patient with advanced CKD.

Publication types

Case Reports
Research Support, Non-U.S. Gov't

MeSH terms

Anti-Inflammatory Agents / therapeutic use
Antifungal Agents / therapeutic use
Cryptococcosis / complications*
Cryptococcosis / drug therapy
Cryptococcosis / microbiology
Cryptococcus neoformans
Humans
Immune Reconstitution Inflammatory Syndrome / complications*
Immune Reconstitution Inflammatory Syndrome / drug therapy
Lung Diseases / complications*
Lung Diseases / drug therapy
Lung Diseases / microbiology
Male
Methylprednisolone / therapeutic use
Middle Aged
Renal Insufficiency, Chronic / complications*

Substances

Anti-Inflammatory Agents
Antifungal Agents
Methylprednisolone