Síndrome de restauración inmune asociado a tratamiento antirretroviral y criptococosis meníngea: Caso clínico / Inflammatory reconstitution immune syndrome associated to antiretroviral therapy and meningeal cryptococcosis
Rev. méd. Chile
; 134(10): 1310-1314, oct. 2006. ilus
Article
em Es
| LILACS
| ID: lil-439924
Biblioteca responsável:
BR1.1
ABSTRACT
The objective of high activity antiretroviral therapy (HAART) in patients with AIDS, is to obtain immune restoration. This means a reduction of the viral load and restitution of the CD4 cell count. A decreased rate of HIV replication improves both the number and function of CD4 cells. Nevertheless, this treatment sometimes results in the reappearance of previous symptoms from treated conditions due to opportunistic infections (ie tuberculosis, criptococcosis, hepatitis, Pneumocystis jirovesi, toxoplasmosis, etc) or non infectious condition such as sarcoidosis, Graves disease or Kaposi sarcoma. This is known as Inflammatory Reconstitution Immune Syndrome (IRIS). We report a 37 year-old woman in stage C3-AIDS with a previous criptococcal meningitis. She was treated, achieving a marked improvement with treatment and subsequent suppressive therapy with fluconazole 200 mg/day. IRIS appeared after 8 months of ongoing antiretroviral therapy with immune restoration with the development of aseptic meningitis and intracranial hypertension. The opportunistic agent could not be identified by cultures. Additional laboratory tests excluded toxoplasmosis, tuberculosis, bacterial cerebral abscesses, syphilitic cerebral gummas, and lymphoma. Brain CT and magnetic resonance studies were compatible with brain vasculitis and leptomeningitis. The patient condition improved with general measures, such as a repeated lumbar punctures and non steroidal anti-inflammatory drugs. We conclude that this patient had an IRIS due to a Cryptococcus neoformans antigen.
Texto completo:
1
Bases de dados:
LILACS
Assunto principal:
Síndrome da Imunodeficiência Adquirida
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Meningite Criptocócica
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Infecções Oportunistas Relacionadas com a AIDS
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Terapia Antirretroviral de Alta Atividade
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Síndrome Inflamatória da Reconstituição Imune
Tipo de estudo:
Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Female
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Humans
Idioma:
Es
Revista:
Rev Med Chil
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Rev. méd. Chile
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Rev. méd. Chile (En línea)
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Revista médica de Chile
Assunto da revista:
MEDICINA
Ano de publicação:
2006
Tipo de documento:
Article
País de afiliação:
Chile