We report a case of a symptomatic relapse of HIV-related cryptococcal meningoencephalitis eight years after the first diagnosis on the background of immune reconstitution. The findings as well as the clinical course suggests a combination of smouldering localised infection and enhanced inflammatory reaction related to immune restoration due to antiretroviral therapy. A combination of antifungal and anti-inflammatory therapy resulted in clinical and radiological improvement. Our case challenges the concept that immune reconstitution inflammatory syndrome and microbiological relapse are dichotomous entities.
Keywords: AIDS; CNS cryptococcosis; Cryptococcus neoformans; HIV; IRIS; antiretroviral therapy; cryptococcal meningitis; immune restoration; opportunistic infection.
© The Author(s) 2015.