The Immune Inflammatory Reconstitution Syndrome and Central Nervous System Toxoplasmosis
Authors: Ivo W. Tremont-Lukats, Pedro Garciarena, Ruben Juarbe, Rima N. El-Abassi
Journal: Annals of Internal Medicine (2009)

Letters5 May 2009The Immune Inflammatory Reconstitution Syndrome and Central Nervous System ToxoplasmosisIvo W. Tremont-Lukats, MD, Pedro Garciarena, MD, Rubén Juarbe, MD, and Rima N. El-Abassi, MDIvo W. Tremont-Lukats, MDFrom University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, and Louisiana State University, New Orleans, LA 70119., Pedro Garciarena, MDFrom University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, and Louisiana State University, New Orleans, LA 70119., Rubén Juarbe, MDFrom University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, and Louisiana State University, New Orleans, LA 70119., and Rima N. El-Abassi, MDFrom University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, and Louisiana State University, New Orleans, LA 70119.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-150-9-200905050-00025 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: The immune inflammatory reconstitution syndrome (IRIS) is a paradoxical worsening of an opportunistic infection as CD4 cells proliferate because highly active antiretroviral therapy (HAART) engages antigenic epitopes and triggers an overshooting inflammatory response. A weak link exists between IRIS and the most frequent neurologic complication of AIDS, central nervous system (CNS) toxoplasmosis.Objective: To show that IRIS can also occur in CNS toxoplasmosis and to share our approach to the problem.Case Report: In early September 2008, we admitted a 30-year-old woman with headaches, imbalance, and left-sided weakness for 1 week. She had untreated HIV-1 infection diagnosed 6 months ...References1. Dhasmana DJ, Dheda K, Ravn P, Wilkinson RJ, Meintjes G. Immune reconstitution inflammatory syndrome in HIV-infected patients receiving antiretroviral therapy: pathogenesis, clinical manifestations and management. Drugs. 2008;68:191-208. [PMID: 18197725] CrossrefMedlineGoogle Scholar2. Shelburne SA, Visnegarwala F, Darcourt J, Graviss EA, Giordano TP, White AC, et al. Incidence and risk factors for immune reconstitution inflammatory syndrome during highly active antiretroviral therapy. AIDS. 2005;19:399-406. [PMID: 15750393] CrossrefMedlineGoogle Scholar3. Riedel DJ, Pardo CA, McArthur J, Nath A. Therapy Insight: CNS manifestations of HIV-associated immune reconstitution inflammatory syndrome. Nat Clin Pract Neurol. 2006;2:557-65. [PMID: 16990829] CrossrefMedlineGoogle Scholar4. Venkataramana A, Pardo CA, McArthur JC, Kerr DA, Irani DN, Griffin JW, et al. Immune reconstitution inflammatory syndrome in the CNS of HIV-infected patients. Neurology. 2006;67:383-8. [PMID: 16894096] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, and Louisiana State University, New Orleans, LA 70119.Acknowledgment: The authors thank Marc K. Rosenblum, MD, who provided panel D of the Figure.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByOpportunistische Infektionen des Nervensystems bei AIDSToxoplasmosis-associated IRIS involving the CNS: a case report with longitudinal analysis of T cell subsetsImmune reconstitution inflammatory syndrome associated with toxoplasmic encephalitis in HIV-infected patientsImmune Reconstitution Inflammatory Syndrome (IRIS)Immune Reconstitution Inflammatory Syndrome (IRIS)Management of Opportunistic Infections Associated with Human Immunodeficiency Virus InfectionCentral Nervous System Immune Reconstitution Inflammatory SyndromeCNS–Immune Reconstitution Inflammatory Syndrome in the Setting of HIV Infection, Part 2: Discussion of Neuro–Immune Reconstitution Inflammatory Syndrome with and without Other PathogensParadoxical immune reconstitution inflammatory syndrome due to toxoplasmic encephalitis: two cases and review of initiation of antiretroviral timing in toxoplasmic encephalitis IRISThe immune reconstitution inflammatory syndrome related to HIV co-infections: a reviewCo-infection of HIV and tropical infectious agents that affect the nervous systemAIDS-associated toxoplasmosisCase 18-2011Immune Reconstitution Inflammatory Syndrome and Cerebral Toxoplasmosis: Fig 1.Immune Reconstitution Inflammatory Syndrome 5 May 2009Volume 150, Issue 9Page: 656-657KeywordsCellsCentral nervous systemHIV-1Highly active antiretroviral therapyImmune responseLymphomaMagnetic resonance imagingOpportunistic infectionsToxoplasma gondiiToxoplasmosis ePublished: 5 May 2009 Issue Published: 5 May 2009 CopyrightCopyright © 2009 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...