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Rapidly enlarging pulmonary mass due to immune reconstitution inflammatory syndrome (IRIS) in an immunocompetent host with pulmonary Cryptococcus neoformans
  1. Mollie Tucker1,
  2. Abdul Majeed Sheikh2 and
  3. Merceditas S Villanueva1
  1. 1Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
  2. 2Infectious Diseases, Charlotte Hungerford Hospital, Torrington, Connecticut, USA
  1. Correspondence to Dr Mollie Tucker; mollie.tucker{at}yale.edu

Abstract

An immunocompetent man presented with Cryptococcus neoformans disease manifesting as a large pulmonary mass (cryptococcoma). Despite an initial induction course of 4 weeks of liposomal amphotericin B (LAmB), followed by 8 weeks of fluconazole, the cryptococcoma enlarged in size. Ten days into a second course of induction therapy with LAmB and flucytosine, the cryptococcoma markedly increased in size with encroachment on critical vascular structures. Due to concern for immune reconstitution inflammatory syndrome (IRIS), prednisone was added with significant decrease in the size of the mass. To our knowledge, this is the first reported case of pulmonary cryptococcal-IRIS in an immunocompetent host.

  • Infectious diseases
  • Cryptococcus
  • Medical management
  • Immunology

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Footnotes

  • Contributors MT created the initial draft of the manuscript and further edited the manuscript for submission. AMS contributed further clinical information to the manuscript and critically edited the manuscript. MSV contributed further research and critically edited the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests MSV was the former PI for Connecticut AIDS Education and Training Center. There are no other competing interests.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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