Abstract
IntroductionImmune reconstitution inflammatory syndrome is a well-known complication in HIV-infected patients after initiation of highly active antiretroviral therapy resulting in rapid CD4+ cell count recovery and suppression of viral load. Generally, immune reconstitution inflammatory syndrome is based on opportunistic infections, but rare cases of immune reconstitution inflammatory syndrome inducing demyelinization of the nervous system have also been observed.Case presentationA 37-year-old African woman with HIV infection diagnosed at 13 years of age was admitted to the emergency department after experiencing backache, severe headache, acute aphasia and psychomotor slowing for one week. Nine weeks earlier, highly active antiretroviral therapy in this patient had been changed because of loss of efficacy, and a rapid increase in CD4+ cell count and decrease of HIV viral load were observed. Magnetic resonance imaging of the brain showed extensive white matter lesions, and analysis of cerebrospinal fluid revealed an immunoreactive syndrome. Intensive investigations detected no opportunistic infections. A salvage therapy, including osmotherapy, corticosteroids and treatment of epileptic seizures, was performed, but the patient died from brainstem herniation 48 hours after admission. Neuropathologic examination of the brain revealed diffuse swelling, leptomeningeal infiltration by CD8 cells and enhancement of perivascular spaces by CD8+ cells.ConclusionImmune reconstitution inflammatory syndrome in this form seems to represent a severe autoimmunologic disease of the brain with specific histopathologic findings. This form of immune reconstitution inflammatory syndrome did not respond to therapy, and extremely rapid deterioration led to death within two days. Immune reconstitution inflammatory syndrome may also occur as severe leukoencephalopathy with fulminant cerebral edema during HIV infection with rapid immune reconstitution.
Highlights
Immune reconstitution inflammatory syndrome is a well-known complication in HIV-infected patients after initiation of highly active antiretroviral therapy resulting in rapid CD4+ cell count recovery and suppression of viral load
Immune reconstitution inflammatory syndrome in this form seems to represent a severe autoimmunologic disease of the brain with specific histopathologic findings. This form of immune reconstitution inflammatory syndrome did not respond to therapy, and extremely rapid deterioration led to death within two days
Up to 37% of these patients may develop an immune reconstitution inflammatory syndrome (IRIS) mainly when highly active antiretroviral therapy (HAART) is started in antiretroviral-naïve patients, who develop a rapid recovery of immune function [1,2,3,4]
Summary
If distinct neurologic symptoms appear in HIV-1infected patients after initiation of HAART and initial clinical improvement, central nervous system IRIS should be considered. Consent Written informed consent was obtained from the patient's next-of-kin for publication of this case report and any accompanying images. Authors' contributions CO was responsible for the medical care of the patient and was the major contributor in writing the manuscript, RD was the head of the intensive care unit, JM was the responsible for the medical care in the intensive care unit, TN analyzed the radiologic examination, EBR is the department chair and IWH was the head of the division of neuro-AIDS and was a contributor in writing the manuscript. Author Details 1University Hospital Muenster, Department of Neurology, A.-Schweitzer-Str. 33, D-48129 Muenster, Germany, 2University Hospital Muenster, Department of Internal Medicine, A.-Schweitzer-Str. 33, D-48129 Muenster, Germany and 3University Hospital Muenster, Institute for Clinical Radiology, A.-Schweitzer-Str. 33, D-48129 Muenster, Germany.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
