Page 22 - Delaware Medical Journal - September 2017
P. 22
Jeremie Axe, MD Michael Axe, MD Alex Bodenstab, MD Drew Brady, MD Evan Crain, MD Adam Ginsberg, DO
Heather Gotha, MD Eric Johnson, MD Randeep Kahlon, MD Stephen Manifold, MD Irene Mavrakakis, MD James Moran, DO Michael Pushkarewicz, MD Bruce Rudin, MD
Craig Smucker, MD David Sowa, MD
Joseph Straight, MD Steven Tooze, MD James Zaslavsky, DO
are pleased to announce that
Specializing in: Orthopaedic Hand
& Upper Extremity Surgery
has joined them in practice at
737 South Queen Strret Dover, DE 19904 (302) 672-7700
Milford, DE 19963 (302) 735-8700
100 South Main Street, Suite 300 Smyrna, DE 19977
(302) 653-5100
Elevated CRP is associated with increased IRIS events and there is 8
cryptococcomas, dilated Virchow-Robin spaces, or cortical nodules.9 The dilated Virchow-Robin spaces, an immunologic, perivascular space, are often found in the basal ganglia and thalami. Their dilation results from the gelatinous material produced by budding yeast
cells, providing the name gelatinous pseudocysts.9-11 While some
In those individuals who develop new symptoms suggestive of 7,10,12 Although previously immunocompromised patients must make physicians suspicious for IRIS.
though there is no consensus on dose or route of administration. There is agreement on using tapering doses of steroids over
months, particularly in patients with severe organ dysfunction,
life threatening conditions, or CNS manifestations.13 Attempts to reduce the incidence of IRIS includes the recommendation to reduce immunosuppressive medications slowly in those with a history of organ transplantation or on steroids.5 Complications from CM-IRIS includes increased ICP, which can occur in 2/3 of cases. Serial lumbar puncture or ventriculoperitoneal shunt may be needed.14
CONCLUSION
CM-IRIS occurs in immunocompromised patients outside of the HIV patient population, and needs to be considered in patients who have paradoxically worsened after meningitis treatment. It is not clinical failure of antifungal therapies but instead a dysregulated immune response. The diagnosis of CM-IRIS is one of exclusion,
ACKNOWLEDGEMENT
The authors would like to thank Michael Spina, MD for his help
CONTRIBUTING AUTHORS
■ PAMELA BAILEY, DO was an Internal Medicine Resident At Christiana Care Health System in Newark, Del. at the time of this case report. She is now an Infectious Disease Fellow at Virginia Commonwealth University Health System in Richmond, Va.
■ CHAD DUFFALO, MD, MPH is an Infectious Disease Physician at Christiana Care Health System in Newark, Del.
