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, 19, e00699
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Immune Reconstitution Inflammatory Syndrome Following Cryptococcal neoformans Infection in an Immunocompetent Host: A Case Report and Review of the Literature

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Case Reports

Immune Reconstitution Inflammatory Syndrome Following Cryptococcal neoformans Infection in an Immunocompetent Host: A Case Report and Review of the Literature

Raguharan Kathiresu et al. IDCases.

Abstract

We present a case of Cryptococcus neoformans in an immunocompetent middle-aged woman with a disseminated manifestation of pulmonary cryptoccoma and cryptococcal meningitis resulting in bilateral blindness. The presentation was complicated by delayed diagnosis resulting in optic neuritis and an infected percutaneous lumbar drainage with methicillin resistant staphylococcus aureus (MRSA) and a paradoxical reaction of suspected immune reconstitution inflammatory syndrome (IRIS). We discuss the pathogen, the clinical manifestations and diagnostic approach (through laboratory and radiology findings), differential diagnosis, treatment, and proposed pathogenesis of IRIS and C. neoformans in an immunocompetent patient.

Keywords: Atypical presentations; C. neoformans; Cryptococcus.

Conflict of interest statement

None of the authors have any conflicts of interest to disclose with regards to this paper.

Figures

Fig. 1
Fig. 1
Chest Radiograph shows an opacity in the right midzone with an ovoid, well-defined fluid density structure in the superior aspect of the right middle lobe measuring 3.4 × 2 cm in maximal axial dimensions.
Fig. 2
Fig. 2
CT tomography of chest in axial and coronal view shows middle lobe consolidation of the Right lung, suggestive of cryptoccoma.
Fig. 3
Fig. 3
MRI-FLAIR (Fluid-attenuated inversion recovery) study depicting gyro hyper-intensity on the FLAIR study pre-contrast and post-contrast. The post contrast MRI image depicts meningeal enhancement through gyro hyper-intensity on the FLAIR study.

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References

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