Post-Infectious Inflammatory Response Syndrome in an HIV-Negative Immunocompetent Elderly Patient With Cryptococcal Meningitis: A Case Report and Literature Review

Front Immunol. 2022 Feb 23:13:823021. doi: 10.3389/fimmu.2022.823021. eCollection 2022.

Abstract

We report a previously healthy 82-year-old male with cryptococcal meningitis (CM) who represented neurological deterioration due to post-infectious inflammatory response syndrome (PIIRS) occurring in 4 months after initial antifungal therapy. He was treated with corticosteroids for 2 months and recovered clinically. However, the clinical manifestation, cerebrospinal fluid (CSF), and brain magnetic resonance imaging (MRI) results got worse again on the next day after corticosteroid withdrawal. The analysis of inflammatory cytokines and culture on CSF, as well as brain MRI, still suggested a diagnosis of PIIRS. Therefore, corticosteroid therapy was used again and he subsequently obtained a complete resolution of symptoms.

Keywords: brain MRI; cerebrospinal fluid; corticosteroids; cryptococcal meningitis (CM); elderly patients; post-infectious inflammatory response syndrome.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Aged
  • Aged, 80 and over
  • Communicable Diseases* / drug therapy
  • HIV Infections* / drug therapy
  • Humans
  • Male
  • Meningitis, Cryptococcal* / diagnosis
  • Meningitis, Cryptococcal* / drug therapy
  • Syndrome

Substances

  • Adrenal Cortex Hormones