Cryptococcal lymphadenitis as a manifestation of immune reconstitution inflammatory syndrome in an HIV-positive patient: A case report and review of the literature

L. Putignani, G. Antonucci, M. G. Paglia, L. Vincenzi, A. Festa, P. de Mori, L. Loiacono, P. Visca

Research output: Contribution to journalArticle

Abstract

Cryptococcus neoformans infections are typically associated with T-cell deficiencies, including acquired immunodeficiency syndrome (AIDS). Although highly active antiretroviral therapy (HAART) has strongly reduced AIDS-related opportunistic infections, the restoration and reactivation of CD4+ cells can induce an immune reconstitution inflammatory syndrome (IRIS), consisting in a deregulated inflammatory response to latent infectious pathogens and/or to their residual antigens. Cryptococcal lymphadenitis has occasionally been documented in IRIS. Here we report a case of histology- and culture-negative cryptococcal lymphadenitis associated with IRIS in an adult AIDS patient with a history of disseminated cryptococcosis, after the start of fully adherent HAART. Appropriate diagnosis was established on nested-PCR and sequence analysis of the interspacer region 2 of C. neoformans ribosomal DNA, and detection of slow-growing blastospores in enrichment cultures of fine-needle lymph node aspirate. Review of recent literature and our case findings suggest that IRIS-associated cryptococcal lymphadenitis is more likely the flare up of a latent infection rather than an immunopathological response to residual antigen of unviable cryptococci.

Original languageEnglish
Pages (from-to)751-756
Number of pages6
JournalInternational Journal of Immunopathology and Pharmacology
Volume21
Issue number3
Publication statusPublished - Jul 2008

Keywords

  • AIDS
  • Cryptococcus neoformans
  • Immune reconstitution inflammatory syndrome
  • Lymphadenitis
  • Molecular detection

ASJC Scopus subject areas

  • Immunology
  • Immunology and Allergy
  • Pharmacology

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