Park Ji Young, Kim Min Jeong
Kosin University College of Medicine, Busan, Korea.
J Investig Med High Impact Case Rep. 2014 Apr 30;2(2):2324709614533951. doi: 10.1177/2324709614533951. eCollection 2014 Apr-Jun.
Background. Highly active antiretroviral therapy (HAART) has contributed to reducing the occurrence of opportunistic infections and mortality in human immunodeficiency virus (HIV) infected patients. However, a paradoxical worsening of clinical signs and symptoms among patients during HAART may occur. Immune reconstitution inflammatory syndrome (IRIS) is described as a paradoxical deterioration of clinical status on initiation of HAART in patients with HIV infection. Case Report. We describe the case of a 41-year-old man with opportunistic cryptococcal encephalitis who exhibited neurological and radiological deterioration during the course of HAART. A diagnosis of central nervous system (CNS)-IRIS was based on a decrease of HIV-RNA viral load greater than 1 log, with an increase in CD4(+) T-cell count from baseline. Conclusions. Differential diagnosis of this paradoxical deterioration in clinical and neurological status from overwhelming opportunistic infection is important; it enables an avoidance of unnecessary diagnostic procedures and proper management of this HIV-associated CNS disorder.
背景。高效抗逆转录病毒疗法（HAART）有助于降低人类免疫缺陷病毒（HIV）感染患者发生机会性感染的几率及死亡率。然而，接受HAART治疗的患者临床体征和症状可能会出现矛盾性恶化。免疫重建炎症综合征（IRIS）被描述为HIV感染患者开始接受HAART治疗时临床状况的矛盾性恶化。病例报告。我们描述了一名41岁患机会性隐球菌性脑炎男性患者的病例，该患者在HAART治疗过程中出现神经和影像学恶化。中枢神经系统（CNS）-IRIS的诊断依据是HIV-RNA病毒载量下降超过1个对数，且CD4(+)T细胞计数较基线水平增加。结论。将这种临床和神经状态的矛盾性恶化与严重的机会性感染进行鉴别诊断很重要；这有助于避免不必要的诊断程序，并对这种与HIV相关的中枢神经系统疾病进行妥善管理。
