Cryptococcal Post Inflammatory Immune Response Syndrome (PIIRS): A Shrewd Masquerader of Immune Cryptococcal Reconstitution Inflammatory Syndrome (IRIS) in Immunosuppressed Patients

Sriharsha Kanuri*, Christina C-PA, Anupa Rai and Saeed Baloch
 

Saint Francis Emory Medical Center Columbus, GA, United States
Piedmont Medical Center, Columbus, GA, United States

^*Correspondance to: Sri Harsha Kanuri  

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Abstract:

Introduction: Cryptococcal meningitis in more common in HIV patients as compared to immunocompetent patients. In immunocompetent patients, despite robust antifungal therapeutic regimens, some patients experience sudden clinical worsening due to Cryptococcal Post Inflammatory Response Syndrome (C-PIIRS). Here, we briefly describe a clinical case and review the current literature on C-PIIRS in immunocompetent in patients. Clinical Case: 64-year-old male with a PMH [Past medical history) of hypertension, myocardial infarction, pulmonary MAC (Mycobacterium avium complex), presented with bilateral lower extremity weakness and lethargy. He was diagnosed with cryptococcal meningitis and treated with antifungal therapy and discharged. After discharge he was again readmitted few weeks later with complaints of bilateral lower extremity weakness, mental status changes and lethargy. MRI brain showed new brain lesions. Due to high suspicion for cryptococcal C-PIIRS decision to restart induction antifungal regimen in combination of corticosteroids was made and patient demonstrated clinical recovery. Discussion: Cryptococcal Post Inflammatory Immune Response Syndrome (C-PIIRS) develops after the resolution of cryptococcal meningitis with sudden appearance of new clinical symptoms, worsening neurological deficits, and new radiological signs in the face of concluded antifungal treatment, and negative fungal cultures. The principal underlying pathophysiological aberration in C-PIIRS is T-lymphocyte-macrophage dissociation. Conclusion: Clinicians should be cognizant of C-PIIRS in any immunocompetent patient who demonstrates clinical worsening after conclusion of antifungal therapy in cryptococcal meningitis. Corticosteroids in combination with antifungal therapy would be reasonable for favorable clinical outcomes and fair prognosis.

Keywords:

Cryptococcal; Clinical symptoms; Antigens

Cite the Article:

Kanuri S, Christina C-PA, Rai A, Baloch S. Cryptococcal Post Inflammatory Immune Response Syndrome (PIIRS): A Shrewd Masquerader of Immune Cryptococcal Reconstitution Inflammatory Syndrome (IRIS) in Immunosuppressed Patients. Clin Case Rep Int. 2026; 10: 1797..