, Volume 183, Issue 3, pp 495–498 | Cite as

Opinion: Paracoccidioidomycosis and HIV Immune Recovery Inflammatory Syndrome

  • Renata Buccheri
  • Gil Benard
Opinion Paper


Two distinct patterns of immune recovery inflammatory syndrome (IRIS) are recognized, paradoxical and unmasking IRIS. Here we raise some concerns regarding the first case of neuroPCM-IRIS published to date, as recently proposed by Almeida and Roza (Mycopathologia 177:137–141, 2017) for a patient originally described by Silva-Vergara et al. (Mycopathologia 182:393–396, 2014), taking in account the different case definitions for IRIS and the cases of neuroparacoccidioidomycosis already described in the literature. We are concerned that data from the case report have been misinterpreted and that no regard has been given to the possibility that the development of manifestations of neuroPCM after starting antiretroviral therapy and antifungal treatments could represent the predicted course of a missed neuroPCM diagnosis at presentation whose treatment failed. We hypothesize that diagnosis of the neuroPCM would not have been missed if careful screening for opportunistic infection of the central nervous system was performed prior to antiretroviral therapy initiation. Currently, there is no definitive diagnostic test for IRIS and diagnostic suspicion, as well as its management, are based on image studies and non-specific clinical signs and symptoms of inflammation. IRIS remains a diagnosis of exclusion, after considering drug toxicity, microbiologic treatment failure and the expected course of newly or previously diagnosed opportunistic infections.


Paradoxical IRIS Unmasking IRIS Paracoccidioidomycosis HIV 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Standards

There was no research involving human participants or animals.


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Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2017

Authors and Affiliations

  1. 1.Instituto de Infectologia Emílio RibasSão PauloBrazil
  2. 2.Laboratory of Medical Investigation Unit #53, Medical School and Tropical Medicine InstituteUniversity of São Paulo Medical SchoolSão PauloBrazil
  3. 3.Laboratories of Medical Investigation Units #53 and #56, Medical School and Tropical Medicine InstituteUniversity of São Paulo Medical SchoolSão PauloBrazil

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