Skip to main content

Advertisement

SpringerLink
Log in

Paradoxical cryptococcal immune reconstitution inflammatory syndrome in advanced chronic kidney disease

  • Nephrology – Case Report
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Cryptococcal-related immune reconstitution inflammatory syndrome (IRIS) is frequently seen in immunocompromised patients. A 45-year-old man with advanced chronic kidney disease (CKD) received intensive antifungal treatment for pulmonary cryptococcosis. Despite negative pleural effusion cultures and declining serum cryptococcal antigen titers, the patient presented with progressive pulmonary infiltration, intermittent fever, and elevated C-reactive protein. Steroids were given for suspected IRIS, and the clinical condition improved dramatically. This is the first report on paradoxical cryptococcal IRIS in a patient with advanced CKD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

References

  1. Light RW, Macgregor MI, Luchsinger PC, Ball WC Jr (1972) Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med 77:507–513

    Article  PubMed  CAS  Google Scholar 

  2. DeSimone JA, Pomerantz RJ, Babinchak TJ (2000) Inflammatory reactions in HIV-1-infected persons after initiation of highly active antiretroviral therapy. Ann Intern Med 133:447–454

    Article  PubMed  CAS  Google Scholar 

  3. Garcia Vidal C, Rodriguez Fernandez S, Martinez Lacasa J, Salavert M, Vidal R, Rodriguez Carballeira M, Garau J (2005) Paradoxical response to antituberculous therapy in infliximab-treated patients with disseminated tuberculosis. Clin Infect Dis 40:756–759

    Article  PubMed  Google Scholar 

  4. Sansonetti P, Lagrange PH (1981) The immunology of leprosy: speculations on the leprosy spectrum. Rev Infect Dis 3:422–469

    Article  PubMed  CAS  Google Scholar 

  5. Cheng VC, Yuen KY, Chan WM, Wong SS, Ma ES, Chan RM (2000) Immunorestitution disease involving the innate and adaptive response. Clin Infect Dis 30:882–892

    Article  PubMed  CAS  Google Scholar 

  6. Cadena J, Thompson GR 3rd, Ho TT, Medina E, Hughes DW, Patterson TF (2009) Immune reconstitution inflammatory syndrome after cessation of the tumor necrosis factor alpha blocker adalimumab in cryptococcal pneumonia. Diagn Microbiol Infect Dis 64:327–330

    Article  PubMed  Google Scholar 

  7. Singh N, Lortholary O, Alexander BD, Gupta KL, John GT, Pursell K, Munoz P, Klintmalm GB, Stosor V, del Busto R, Limaye AP, Somani J, Lyon M, Houston S, House AA, Pruett TL, Orloff S, Humar A, Dowdy L, Garcia-Diaz J, Kalil AC, Fisher RA, Husain S (2005) An immune reconstitution syndrome-like illness associated with cryptococcus neoformans infection in organ transplant recipients. Clin Infect Dis 40:1756–1761

    Article  PubMed  CAS  Google Scholar 

  8. Haddow LJ, Colebunders R, Meintjes G, Lawn SD, Elliott JH, Manabe YC, Bohjanen PR, Sungkanuparph S, Easterbrook PJ, French MA, Boulware DR (2010) Cryptococcal immune reconstitution inflammatory syndrome in HIV-1-infected individuals: proposed clinical case definitions. Lancet Infect Dis 10:791–802

    Article  PubMed  Google Scholar 

  9. Achenbach CJ, Harrington RD, Dhanireddy S, Crane HM, Casper C, Kitahata MM (2012) Paradoxical immune reconstitution inflammatory syndrome in HIV-infected patients treated with combination antiretroviral therapy after AIDS-defining opportunistic infection. Clin Infect Dis 54:424–433

    Article  PubMed  CAS  Google Scholar 

  10. da Cunha Colombo ER, Mora DJ, Silva-Vergara ML (2011) Immune reconstitution inflammatory syndrome (IRIS) associated with cryptococcus neoformans infection in AIDS patients. Mycoses 54:e178–e182

    Article  PubMed  Google Scholar 

  11. Woods ML II, MacGinley R, Eisen DP, Allworth AM (1998) HIV combination therapy: partial immune restitution unmasking latent cryptococcal infection. AIDS 12:1491–1494

    Article  PubMed  CAS  Google Scholar 

  12. Lortholary O, Fontanet A, Memain N, Martin A, Sitbon K, Dromer F (2005) Incidence and risk factors of immune reconstitution inflammatory syndrome complicating HIV-associated cryptococcosis in France. AIDS 19:1043–1049

    Article  PubMed  Google Scholar 

  13. Rambeloarisoa J, Batisse D, Thiebaut JB, Mikol J, Mrejen S, Karmochkine M, Kazatchkine MD, Weiss L, Piketty C (2002) Intramedullary abscess resulting from disseminated cryptococcosis despite immune restoration in a patient with AIDS. J Infect 44:185–188

    Article  PubMed  CAS  Google Scholar 

  14. Skiest DJ, Hester LJ, Hardy RD (2005) Cryptococcal immune reconstitution inflammatory syndrome: report of four cases in three patients and review of the literature. J Infect 51:e289–e297

    Article  PubMed  Google Scholar 

  15. Jenny-Avital ER, Abadi M (2002) Immune reconstitution cryptococcosis after initiation of successful highly active antiretroviral therapy. Clin Infect Dis 35:e128–e133

    Article  PubMed  Google Scholar 

  16. Ratnam I, Chiu C, Kandala NB, Easterbrook PJ (2006) Incidence and risk factors for immune reconstitution inflammatory syndrome in an ethnically diverse HIV type 1-infected cohort. Clin Infect Dis 42:418–427

    Article  PubMed  CAS  Google Scholar 

  17. Murdoch DM, Venter WD, Feldman C, Van Rie A (2008) Incidence and risk factors for the immune reconstitution inflammatory syndrome in HIV patients in South Africa: a prospective study. AIDS 22:601–610

    Article  PubMed  CAS  Google Scholar 

  18. Tranaeus A, Yao Q (2008) Immune dysfunction in dialysis patients–prevention and treatment strategies. Perit Dial Int 28(Suppl 3):S161–S166

    PubMed  Google Scholar 

  19. Abbott KC, Hypolite I, Tveit DJ, Hshieh P, Cruess D, Agodoa LY (2001) Hospitalizations for fungal infections after initiation of chronic dialysis in the United States. Nephron 89:426–432

    Article  PubMed  CAS  Google Scholar 

  20. Raska K Jr, Raskova J, Shea SM, Frankel RM, Wood RH, Lifter J, Ghobrial I, Eisinger RP, Homer L (1983) T cell subsets and cellular immunity in end-stage renal disease. Am J Med 75:734–740

    Article  PubMed  Google Scholar 

  21. Kaul H, Girndt M, Sester U, Sester M, Kohler H (2000) Initiation of hemodialysis treatment leads to improvement of T-cell activation in patients with end-stage renal disease. Am J Kidney Dis 35:611–616

    Article  PubMed  CAS  Google Scholar 

  22. Shelburne SA III, Hamill RJ, Rodriguez-Barradas MC, Greenberg SB, Atmar RL, Musher DW, Gathe JC Jr, Visnegarwala F, Trautner BW (2002) Immune reconstitution inflammatory syndrome: emergence of a unique syndrome during highly active antiretroviral therapy. Medicine 81:213–227

    Article  PubMed  Google Scholar 

  23. Huits RM, Bremmer R, Enting RH, Sprenger HG, van Assen S (2007) Return of meningeal symptoms in a patient treated for cryptococcal meningitis. J Neurol 254:1443–1444

    Article  PubMed  Google Scholar 

  24. Manfredi R, Pieri F, Pileri SA, Chiodo F (1999) The changing face of AIDS-related opportunism: cryptococcosis in the highly active antiretroviral therapy (HAART) era. Case reports and literature review. Mycopathologia 148:73–78

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This study was supported by The Ta-Tung Kidney Foundation and Taiwan National Science Council (grant NSC 100-2314-B-002-147-MY3, NSC 100-2314-B-002-119-) and NTUH.098-001177, NTUH 100-001667.

Author information

Authors and Affiliations

  1. Division of Nephrology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan

    Chih-Chin Kao & Vin-Cent Wu

  2. Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan

    Hsin-Yun Sun

  3. Division of Nephrology, Buddhist Tzu Chi General Hospital, Taipei Branch, No. 289, Jianguo Rd., Xindian, New Taipei, 23142, Taiwan

    Che-Hsiung Wu

Authors
  1. Chih-Chin Kao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vin-Cent Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hsin-Yun Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Che-Hsiung Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

The NSARF Group

Corresponding author

Correspondence to Che-Hsiung Wu.

Additional information

The NSARF Group: National Taiwan University Hospital Study Group on Acute Renal Failure (NSARF).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kao, CC., Wu, VC., Sun, HY. et al. Paradoxical cryptococcal immune reconstitution inflammatory syndrome in advanced chronic kidney disease. Int Urol Nephrol 45, 1505–1509 (2013). https://doi.org/10.1007/s11255-012-0196-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-012-0196-y

Keywords

Search

Navigation