Central nervous system immune reconstitution disease presenting with vasculitis-like lesions

The immune reconstitution inflammatory syndrome (IRIS) identifies a spectrum of clinico-pathological entities resulting from either paradoxical worsening or unmasking of previously quiescent disorders following the initiation of combination antiretroviral therapy (cART). The central nervous system (CNS) is a major target tissue for IRIS, and inflammatory forms of cryptococcosis and progressive multifocal leukoencephalopahy (PML) are well known manifestations of CNS-IRIS. We here describe the case of a patient who developed focal neurological disease two months after initiation of cART and one month after successfully treated herpes zoster. Magnetic resonance imaging (MRI) showed vasculitis-like lesions but cerebrospinal fluid analysis failed to reveal the presence of varicella-zoster virus or other opportunistic pathogens. The clinical and radiological picture improved dramatically following treatment with intravenous high dose corticosteroids and remained stable during the subsequent follow-up. CNS-IRIS may present in the form of vasculitis-like inflammatory CNS lesions that respond to anti-inflammatory treatment.
Keywords: HIV; IRIS; Central Nervous System.

Articolo presente in – HAART and correlated pathologies n. 2

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