Criptococosis meníngea en inmunosuprimidos: rol del síndrome inflamatorio de reconstitución inmune

The immune reconstitution inflammatory syndrome (IRIS) is an uncommon but serious complication that increases the morbi-mortality of some patients whose immune status begins to recover following immunosuppressant withdrawal, therefore responding to a previously acquired opportunistic infection. Such response is excessive and worsens the symptoms of the infection, leading to a severe and paradoxical deterioration of clinical status despite appropriate ongoing therapy for the infection. We present the case of a 67-year-old female with immunosuppression following hepatorenal transplantation, who exhibited general deterioration with decrease in food intake, somnolence and headache. She was diagnosed with meningeal cryptococcosis and initiated antifungal treatment with an initial favorable response. Two months after the patient suffered a relapse of her symptoms after which added greater neurological involvement. The present case report identifies the differential diagnoses that should be taken into account in cases similar to the one presented by our patient, highlighting the importance of considering the IRIS.