Unmasking cryptococcal meningitis immune reconstitution inflammatory syndrome in pregnancy induced by HIV antiretroviral therapy with postpartum paradoxical exacerbation

Reuben Kiggundu; Joshua Rhein; David B Meya; David R Boulware; Nathan C Bahr

doi:10.1016/j.mmcr.2014.05.001

Unmasking cryptococcal meningitis immune reconstitution inflammatory syndrome in pregnancy induced by HIV antiretroviral therapy with postpartum paradoxical exacerbation

Med Mycol Case Rep. 2014 May 29:5:16-9. doi: 10.1016/j.mmcr.2014.05.001. eCollection 2014 Jul.

Authors

Reuben Kiggundu¹, Joshua Rhein², David B Meya², David R Boulware³, Nathan C Bahr²

Affiliations

¹ Infectious Disease Institute, Makerere University, Kampala, Uganda.
² Infectious Disease Institute, Makerere University, Kampala, Uganda ; Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA ; Center for Infectious Diseases & Microbiology Translational Research, University of Minnesota, Minneapolis, MN, USA.
³ Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA ; Center for Infectious Diseases & Microbiology Translational Research, University of Minnesota, Minneapolis, MN, USA.

Abstract

Cryptococcosis is the most common cause of meningitis in Africa due to the high burden of HIV. Immune reconstitution inflammatory syndrome (IRIS) is a frequent and deadly complication of cryptococcal meningitis. We report a fatal case of cryptococcal-IRIS in a pregnant woman that began after starting antiretroviral therapy (unmasking IRIS) and markedly worsened postpartum after delivery (paradoxical IRIS).

Keywords: AIDS; Cryptococcus meningitis; HIV; Immune reconstitution inflammatory syndrome; Postpartum; Pregnancy.

Abstract

Grants and funding