SHM Converge Scientific Abstract ePoster Gallery-Acute Unmasking Cryptococcal Meningitis Immune Reconstitution Inflammatory Syndrome (Cm-Iris) in a Patient With History of Non-Compliance Treated Hiv

Acute Unmasking Cryptococcal Meningitis Immune Reconstitution Inflammatory Syndrome (Cm-Iris) in a Patient With History of Non-Compliance Treated Hiv

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Pdf Summary

This case report describes a 39-year-old man with HIV who developed acute unmasking cryptococcal meningitis immune reconstitution inflammatory syndrome (CM-IRIS) after restarting antiretroviral therapy (ART). He had been non-compliant with HIV treatment for years but began taking Biktarvy consistently 3 months before presentation. He arrived to the emergency department with 4 days of worsening headaches and severe projectile vomiting. Initial exam and CT head were unremarkable, and he was first treated empirically with ceftriaxone, acyclovir, dexamethasone, and vancomycin.<br /><br />Further workup revealed a strongly positive serum cryptococcal antigen, and lumbar puncture confirmed cryptococcal meningitis with positive CSF antigen, culture, and PCR. CSF showed lymphocytic predominance, mildly elevated protein, and normal glucose. He was treated with amphotericin B and flucytosine for 5 days, then discharged on fluconazole with follow-up recommendations and repeat LP.<br /><br />The report emphasizes that ART can trigger IRIS, usually within the first 4 months after therapy begins, especially when hidden opportunistic infections are present. In this patient, immune recovery was supported by increased absolute lymphocytes and CD4 count, along with undetectable HIV RNA compared with a viral load of 40,900 copies/mL three months earlier.<br /><br />The authors highlight the importance of carefully reviewing medication adherence history in patients with HIV, since restarting ART after prolonged non-compliance can unmask serious opportunistic infections such as cryptococcal meningitis.

Asset Subtitle

Roop Parlapalli

Meta Tag

Author List Prasanthi Limgala, Qi Shi, Roop Parlapalli, Venu Gopal Kankani

Category Clinical Vignettes

Concept Cryptococcal Meningitis-Associated Immune Reconstitution Inflammatory Syndrome

Concept Cryptococcal Meningitis

Concept Immune Reconstitution Inflammatory Syndrome

Concept HIV Therapy

Concept HIV

Distinguished Non-Finalist

Presenter Organization Geisinger

Presenting Author Roop Parlapalli

Track Adult

Keywords

HIV

cryptococcal meningitis

immune reconstitution inflammatory syndrome

IRIS

antiretroviral therapy

ART restart

cryptococcal antigen

lumbar puncture

amphotericin B

flucytosine

Cryptococcal Meningitis-Associated Immune Reconstitution Inflammatory Syndrome

Cryptococcal Meningitis

Immune Reconstitution Inflammatory Syndrome

HIV Therapy

HIV