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Immune reconstitution inflammatory syndrome: case report A 42-year-old man developed immune reconstitution inflammatory syndrome during treatment with flucytosine and amphotericin B liposomal for Cryptococcus neoformans infection [routes not stated]. The man, who had a history of intellectual impairment, hypertension and type 2 diabetes, developed productive cough, malaise and lethargy. He was a non-smoker and did not drink alcohol or used recreational drugs. Following examinations, he was diagnosed with community-acquired pneumonia. A nasopharyngeal swab was positive for influenza A virus infection. He was treated with azithromycin and amoxicillin for presumed bacterial infection. After 1 week, he returned with persistence of his symptoms. Following examinations, he was diagnosed with hospital-acquired pneumonia and was treated with azithromycin and piperacillin/ tazobactam. Despite 1 week of antibiotic therapy, he remained unwell. The bronchoalveolar fluid yielded Cryptococcus neoformans var. grubii. Subsequently, he started receiving treatment with flucytosine 100 mg/kg-1 day-1 and amphotericin B liposomal [liposomal amphotericin] 4 mg/kg-1. However, his clinical condition deteriorated within 24 hours. He had fever, type 1 respiratory failure which required mechanical ventilation, and anuric renal failure. Chest X-ray revealed extensive pulmonary infiltrates. Repeat bronchoscopy did not yield any new microorganism. The man’s treatment with flucytosine and amphotericin B liposomal was replaced with fluconazole due to a possible drug reaction in the form of immune reconstitution inflammatory syndrome. His condition remained critical for 1 week. He received treatment with hydrocortisone. Within 24 hours, his body temperature decreased. Over the next week, his condition improved. Two months after hospitalisation, he was discharged. McNeil T, et al. Cryptococcal Pneumonia following Influenza in an Immunocompetent Patient. Infectious Diseases in Clinical Practice 28: 158-160, No. 3, May 2020. 803515335 Available from: URL: http://doi.org/10.1097/IPC.0000000000000820

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Reactions 14 Nov 2020 No. 1830