Case Report: A Case of Severe Cryptococcal Immune Reconstitution Inflammatory Syndrome Presenting with Brain and Intradural Abscesses in an HIV Patient

Case Report: A case of Felty's syndrome with initial presentation of pleural effusion and subsequent Escherichia coli pyothorax

Background

Pleural effusion is a common disease in respiratory medicine, and rheumatoid arthritis (RA) is one of the causes of pleural effusion. Felty's syndrome is a special manifestation of RA. We report a case of Felty's syndrome with pleural effusion as the initial symptom and the subsequent diagnosis and treatment of the patient's secondary pyothorax.

Case presentation

We report the case of a 78-year-old male who was admitted to the hospital after more than 1 year of discovered pleural effusion. After consultation with the Department of Rheumatology and Immunology, and considering the patient's symptoms of joint deformity and swelling pain, combined with decreased white blood cells, decreased platelets, and splenomegaly, the patient was diagnosed with RA Felty's syndrome. The patient was treated with iguratimod and methylprednisolone. Three months later, the patient was diagnosed as Escherichia coli empyema. The patient was treated with intravenous and sensitive anti-infection therapy combined with medical thoracoscopy, achieving good therapeutic effects.

Conclusion

Felty's syndrome is a rare manifestation of RA. Pleural effusion may be the initial manifestation of RA, and secondary infections are prone to occur during the treatment of RA and Felty's syndrome. The combination of sensitive antibiotics and medical thoracoscopy can effectively treat secondary pyothorax.

Review: The application of corticosteroids in cryptococcal meningitis

Cryptococcal meningitis (CM) is a serious disease with high morbidity and mortality. Although the patients who received corticosteroids were at high risk of having CM, corticosteroids also have been used as an adjunct to antifungal drugs for treating people with CM in some situations (such as immune reconstitution inflammatory syndrome, cerebral cyptococcoma, et al.). Here, we summarize the current knowledge on the application of the corticosteroids in CM, aiming to help clinicians to reasonably use corticosteroids in patients with CM.

Cryptococcal Immune Reconstitution Inflammatory Syndrome: From Blood and Cerebrospinal Fluid Biomarkers to Treatment Approaches

Immune reconstitution inflammatory syndrome (IRIS) presents as an exaggerated immune reaction that occurs during dysregulated immune restoration in immunocompromised patients in late-stage human immunodeficiency virus (HIV) infection who have commenced antiretroviral treatments (ART). Virtually any opportunistic pathogen can provoke this type of immune restoration disorder. In this review, we focus on recent developments in the identification of risk factors for Cryptococcal IRIS and on advancements in our understanding of C-IRIS immunopathogenesis. We overview new findings in blood and cerebrospinal fluid which can potentially be useful in the prediction and diagnosis of cryptococcal meningitis IRIS (CM-IRIS). We assess current therapeutic regimens and novel treatment approaches to combat CM-IRIS. We discuss the utility of biomarkers for clinical monitoring and adjusting treatment modalities in acquired immunodeficiency syndrome (AIDS) patients co-infected with Cryptococcus who have initiated ART.

Systemic Inflammation Associated with Immune Reconstitution Inflammatory Syndrome in Persons Living with HIV

Antiretroviral therapy (ART) has represented a major advancement in the care of people living with HIV (PLWHH), resulting in significant reductions in morbidity and mortality through immune reconstitution and attenuation of homeostatic disruption. Importantly, restoration of immune function in PLWH with opportunistic infections occasionally leads to an intense and uncontrolled cytokine storm following ART initiation known as immune reconstitution inflammatory syndrome (IRIS). IRIS occurrence is associated with the severe and rapid clinical deterioration that results in significant morbidity and mortality. Here, we detail the determinants underlying IRIS development in PLWH, compiling the available knowledge in the field to highlight details of the inflammatory responses in IRIS associated with the most commonly reported opportunistic pathogens. This review also highlights gaps in the understanding of IRIS pathogenesis and summarizes therapeutic strategies that have been used for IRIS.