Introduction Only 9 cases of AIDS-associated cryptococcosis have been reported by the international literature in patients treated with highly active antiretroviral therapy (HAART), all of them with an abnormal clinical picture. Case reports An atypical relapse of AIDS-related cryptococcosis occurred in two HIV-infected patients shortly after HAART administration, and despite long-term maintenance antifungal treatment. Multiple indolent subcutaneous abscesses with concurrent regional lymph nodes involvement occurred in a patient with successful immunological response to the first three months of HAART (as expressed by a CD4+ count growing from 7 to 186 cells/μL), in absence of either neurological or systemic disease. A cryptococcal etiology was confirmed by both histopathologic study and serum antigen assay, while culture proved repeatedly negative. The second patient experienced a partial immune recovery after HAART (as shown by a CD4+ lymphocyte count ranging from 78 to 149 cells/μL, compared with a baseline level of 98 cells/μL), leading to even 5 different episodes of relapse of cryptococcal meningitis in 22 months. In both episodes, antimycotic treatment (together with antiinflammatory therapy in the first case), tested effective in obtaining complete clinical and microbiological control of disease. Conclusions Both our case reports underline a novel relationship between immune reactivity and opportunistic pathogens, occurring after that HAART became available. The first episode represents an 'immune reconstitution syndrome' with abnormal disease localization and course, probably descending from a latent infection unmasked by an immunologically effective HAART; as a consequence, during the HAART era, the absence of both neurological and systemic involvement and concurrent negative cultures cannot exclude HIV-related cryptococcal disease. On the other hand, the second report describes multiple recurrences of meningeal cryptococcosis despite HOARD and continued maintenance antifungal treatment; this extraordinarily relapsing disease course may result from a reduced immune response to HOARD, responsible for non-eradication of fungal organisms, but also for non-dissemination of disease (usually borne by a lethal outcome in the pre-HAART era).
|Translated title of the contribution||AIDS-related cryptococcosis during highly active antiretroviral therapy (HAART) era: A comparison between two different disease pictures|
|Number of pages||8|
|Journal||Giornale Italiano di Malattie Infettive|
|Publication status||Published - 2000|
ASJC Scopus subject areas
- Microbiology (medical)