Cryptococcal lymphadenitis and immune reconstitution inflammatory syndrome: Current considerations

Abstract

HIV-related immune reconstitution inflammatory syndrome (IRIS) is increasingly being recognized in regions with a high burden of opportunistic infections. We describe an unusual manifestation of IRIS- ‘unmasking’ cryptococcal lymphadenitis in a patient shortly after initiation of antiretroviral therapy. Epidemiology, clinical features and management of cryptococcal IRIS with reference to lymphadenitis presentation are briefly reviewed. Early and accurate diagnosis is essential for appropriate management. Standard antifungal therapy along with continuation of antiretroviral therapy is recommended. Cases with severe inflammation may benefit from anti-inflammatory drugs/corticosteroids. Unusual manifestations like lymphadenitis pose diagnostic difficulties in regions with a high prevalence of tubercular lymphadenitis.

Keywords::

• Cryptococcal lymphadenitis
• immune reconstitution inflammatory syndrome (IRIS)
• human immunodeficiency virus (HIV)

Acknowledgements

We thank the staff at the ART centre, St John's Medical College Hospital, for assistance in the clinical care of the patient.

Declaration of interest: No conflict of interest.