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Immune reconstitutional syndrome neurology

Deepak M W Balak, Enes Hajdarbegovic, Wichor M Bramer, Martino H A Neumann, H Bing Thio
BACKGROUND: Fumaric acid esters (FAEs) are a systemic treatment for psoriasis considered to have a favorable long-term safety profile without an increased risk for immunosuppression. However, progressive multifocal leukoencephalopathy (PML), a rare, opportunistic viral infection of the central nervous system, has been linked anecdotally to FAE treatment. OBJECTIVE: to assess clinical features and outcomes of FAE-associated PML cases. METHODS: Systematic literature search in multiple databases up to February, 25(th) 2016 for reports of PML in psoriasis patients treated with FAEs...
March 21, 2017: Journal of the European Academy of Dermatology and Venereology: JEADV
Rodolfo Mendes Queiroz, Lara Zupelli Lauar, Marcus Vinicius Nascimento Valentin, Cecília Hissae Miyake, Lucas Giansante Abud
No abstract text is available yet for this article.
November 2016: Radiologia Brasileira
Suzaan Marais, Rachel P J Lai, Katalin A Wilkinson, Graeme Meintjes, Anne O'Garra, Robert J Wilkinson
Tuberculous meningitis (TBM) is a frequent cause of meningitis in individuals with human immunodeficiency virus (HIV) infection, resulting in death in approximately 40% of affected patients. A severe complication of antiretroviral therapy (ART) in these patients is neurological tuberculosis-immune reconstitution inflammatory syndrome (IRIS), but its underlying cause remains poorly understood. To investigate the pathogenesis of TBM-IRIS, we performed longitudinal whole-blood microarray analysis of HIV-infected patients with TBM and reflected the findings at the protein level...
March 1, 2017: Journal of Infectious Diseases
Wolfgang Wick, Anne Hertenstein, Michael Platten
Neurological complications of cancer and of anticancer treatments can be substantially disabling to patients, especially with classic chemotherapies. As a rare but important complication, targeted therapies might also result in similar unwanted effects, partly because inhibition of VEGF is a common downstream effect. Therapeutic antibodies, such as the CD20-depleting antibody rituximab, and underlying haematological malignancies, can induce long-lasting cellular immunosuppression, predisposing patients to opportunistic CNS infections, such as progressive multifocal leukoencephalopathy, where treatment-induced recovery can result in severe reconstitution of immune inflammatory syndromes of the central nervous system...
December 2016: Lancet Oncology
Leah T Le, Serena S Spudich
Since the advent of combination antiretroviral therapy (cART), HIV has transformed from a fatal disease to a chronic illness that often presents with milder central nervous system (CNS) symptoms laced with related confounders. The immune recovery associated with access to cART has led to a new spectrum of immune-mediated presentations of infection, phenotypically distinct from the conditions observed in advanced disease.HIV-associated neurocognitive disorder (HAND) entails a categorized continuum of disorders reflecting an array of clinical presentation, outcome, and increasing level of severity: asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND), and HIV-associated dementia (HAD)...
August 2016: Seminars in Neurology
Eliza Manea, Daniela Munteanu, Raluca Jipa, Ruxandra Moroti, Victoria Arama, Ioan-Alexandru Diaconu, Adriana Hristea
BACKGROUND: Immune reconstitution inflammatory syndrome (IRIS) related to tuberculosis (TB) is an exacerbation of an inflammatory response that most often occurs in HIV-infected patients but it has also been observed in non-HIV immunocompromised hosts. We describe two cases of TB associated IRIS with CNS involvement, one in a patient diagnosed with HIV infection and the other in a patient with immunosuppression due to anti tumor necrosis factor treatment. CASE REPORT; The first case was a 40-year-old man, newly diagnosed with HIV infection, who developed right hemiplegia and expressive aphasia...
October 2015: Pneumologia: Revista Societății Române de Pneumologie
Ronald Ellis, Scott L Letendre
The pace of therapeutic developments in HIV presents unique challenges to the neurologist caring for patients. Combination antiretroviral therapy (cART) is remarkably effective in suppressing viral replication, preventing, and often even reversing disease progression. Still, not every patient benefits from cART for a variety of reasons, ranging from the cost of therapy and the burden of lifelong daily treatment to side effects and inadequate access to medical care. Treatment failure inevitably leads to disease progression and opportunistic complications...
July 2016: Neurotherapeutics: the Journal of the American Society for Experimental NeuroTherapeutics
S Deshayes, N Bouvier, V Chatelet, B Hurault de Ligny, S Dargère, J Bonhomme, C Béchade
Cryptococcosis is a major concern in organ transplant recipients. A decrease in immunosuppressants following the initiation of antifungal therapy is currently recommended, but can occasionally be complicated by the onset of immune reconstitution inflammatory syndrome (IRIS). We report on a case of cryptococcosis in a kidney transplant recipient, compounded by severe neurological IRIS, the outcome of which was unfavorable despite the use of anti-tumor necrosis factor-alpha monoclonal antibodies.
June 2016: Transplant Infectious Disease: An Official Journal of the Transplantation Society
S Sainz-de-la-Maza, J L Casado, M J Pérez-Elías, A Moreno, C Quereda, S Moreno, I Corral
BACKGROUND AND PURPOSE: Progressive multifocal leucoencephalopathy-associated immune reconstitution inflammatory syndrome (PML-IRIS) is the paradoxical worsening or unmasking of preexisting infection with JC virus attributable to a rapid recovery of the immune system after highly active antiretroviral therapy (HAART) initiation. We investigated the incidence and factors associated with PML-IRIS in HIV-infected patients. We also studied its influence on mortality of PML and the effect of corticosteroid therapy...
May 2016: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Avindra Nath
PURPOSE OF REVIEW: Neurologic complications of human immunodeficiency virus (HIV) infection remain common, despite effective antiretroviral treatment (ART). Neurologic manifestations may be due to opportunistic infection, immune reconstitution, or the virus itself, posing diagnostic challenges for the neurologist. Neurologists are also asked to comment on the use of immunomodulatory agents in these patients and to manage long-term complications, such as neurocognitive disorders and peripheral neuropathy or the associated comorbidities...
December 2015: Continuum: Lifelong Learning in Neurology
Jared Narvid, Bhavya Rehani, Jason F Talbott
BACKGROUND AND PURPOSE: Central nervous system immune reconstitution inflammatory syndrome (CNS-IRIS) significantly negatively impacts the human immunodeficiency virus (HIV)-infected population on combination antiretroviral therapy (cART). We sought to determine the diagnostic performance of several magnetic resonance imaging (MRI) features for CNS-IRIS in a cohort of HIV+ patients recently started on cART. METHODS: Our radiologic database was searched from January 2003 to September 2014 retrospectively for patients diagnosed with HIV and worsening symptoms on cART...
May 2016: Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging
Maria Letizia Giancola, Francesco Baldini, Carmine Maria Carapella, Elisa Busi Rizzi, Rita Maddaluno, Lucia Alba, Andrea Antinori
The case of an HIV-infected man from Eritrea previously diagnosed with tuberculosis, who presented neurological impairment and cerebral lesion after having voluntarily stopped anti-tubercular and antiretroviral therapies, is here reported. Treatments associated with steroids and mannitol were administered. The patient's condition improved, but neuroimaging showed a continuous worsening of the lesion, while a great immunological reconstitution was observed. Brain microsurgery was performed. A tuberculosis diagnosis was supported by pathological and microbiological examinations...
May 2015: Journal of Infection in Developing Countries
David B Clifford
PURPOSE OF REVIEW: This manuscript reviews current reports about clinical aspects of immune reconstitution inflammatory syndrome (IRIS), with a particular emphasis on IRIS in the setting of progressive multifocal leukoencephalopathy (PML) and to a lesser extent on cryptococcal meningitis and HIV. RECENT FINDINGS: PML prognosis has been radically improved, as it has become possible to provide immune reconstitution, although some remaining morbidity and mortality results from excess inflammation...
June 2015: Current Opinion in Neurology
Robert L Carruthers, Joseph Berger
The natural history and clinical import of Progressive Multifocal Leukoencephalopathy has changed enormously in the last thirty years. After a resurgence of PML during the HIV/AIDS epidemic, advances in the treatment of multiple sclerosis created another group of 'at risk' patients. With a focus on issues pertaining to the multiple sclerosis patient population, this review covers pathophysiology of the JC virus, causes of PML, mechanisms by which natalizumab increases the risk of PML, determinants of PML risk in natalizumab-treated patients, risks of natalizumab discontinuation, PML prevention and surveillance, PML imaging features, PML diagnosis and stumbling blocks to making the diagnosis, PML and PML-Immune Reconstitution Inflammatory Syndrome (IRIS) treatment...
July 2014: Multiple Sclerosis and related Disorders
Concepción García-García, Federico Castillo-Álvarez, José M Azcona-Gutiérrez, María J Herraiz, Valvanera Ibarra, José A Oteo
Neurological complications in patients with human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) are still common, even in the era of highly active antiretroviral therapy. Opportunistic infections, immune reconstitution, the virus itself, antiretroviral drugs and neurocognitive disorders have to be considered when establishing the differential diagnosis. Toxoplasmic encephalitis remains the major cause of space-occupying lesions in the brain of patients with HIV/AIDS; however, spinal cord involvement has been reported infrequently...
May 2015: Infectious Diseases
Toru Tanaka, Akimasa Sekine, Yoshiya Tsunoda, Hiroyuki Takoi, Shin-Yuan Lin, Yohei Yatagai, Kenji Hayasihara, Takefumi Saito
A 64-year-old neurologically asymptomatic woman with rheumatoid arthritis who was treated with the tumor necrosis factor (TNF)-α antagonist adalimumab developed disseminated tuberculosis (TB). After receiving anti-TB therapy and discontinuing adalimumab, she exhibited paradoxical worsening due to immune reconstitution inflammatory syndrome (IRIS) with the appearance of meningitis and brain tuberculomas. This case indicates that continuing anti-TNF therapy may be necessary to prevent IRIS in patients who develop TB, particularly disseminated TB, during the course of anti-TNF therapy...
2015: Internal Medicine
Etienne Ghrenassia, Nihal Martis, Julien Boyer, Fanny Burel-Vandenbos, Arsène Mekinian, Paul Coppo
The Diffuse Infiltrative Lymphocytosis Syndrome (DILS) is a rare multisystemic syndrome described in HIV-infected patients. It is characterised by CD8(+) T-cell lymphocytosis associated with a CD8(+) T-cell infiltration of multiple organs. DILS is usually seen in uncontrolled or untreated HIV infection but can also manifest itself independently of CD4(+) T-cell counts. The syndrome may present as a Sjögren-like disease that generally associates sicca signs with bilateral parotiditis, lymphadenopathy, and extraglandular organ involvement...
May 2015: Journal of Autoimmunity
A Scemla, S Gerber, A Duquesne, P Parize, F Martinez, D Anglicheau, R Snanoudj, M Zuber, M-E Bougnoux, C Legendre, O Lortholary
In solid organ transplant recipients, immune reconstitution inflammatory syndrome (IRIS) is a rare complication of cryptococcosis, which may require steroids in its most severe forms. Here, we report the case of a renal transplant recipient who developed severe cryptococcal meningitis-associated IRIS 1 week after immunosuppression reduction. High-dose steroids failed to improve the disease. Finally, a recombinant human monoclonal tumor necrosis factor-α (TNF-α) antagonist, adalimumab, was prescribed, and the patient rapidly experienced dramatic neurological improvement...
February 2015: American Journal of Transplantation
Mónica Rodríguez, Fernando Antonio Silva-Sánchez, César Luna-Rivero, Ricardo Vega-Barrientos, Claudia Alvarado-de la Barrera, Gustavo Reyes-Terán
Due to the lack of therapeutic options for patients with progressive multifocal leukoencephalopathy-associated immune reconstitution inflammatory syndrome (PML-associated IRIS), maraviroc has generated expectations among the medical community. However, we report a patient with advanced HIV infection, who developed PML-associated IRIS and had a fatal outcome despite the addition of maraviroc to suppressive ART. Future studies are required to define the therapeutic role of maraviroc in PML-associated IRIS and differentiate individuals who may benefit from maraviroc from those who may develop neurological deterioration...
2014: Case Reports in Medicine
Asaf Honig, Dimitrios Karussis
BACKGROUND: Neurological manifestations of West Nile virus infection include meningitis, encephalitis and acute flaccid paralysis. Typically, West Nile virus-associated acute flaccid paralysis is characterized by acute and rapidly progressing limb weakness, occurring early in the course of the disease. CASE PRESENTATION: We report a patient of Yemenite descent who developed West Nile virus-encephalitis and poliomyelitis two weeks following treatment with rituximab for B cell lymphoma, and delayed encephalitis with ascending demyelinating polyneuropathy 6 months later...
2014: BMC Research Notes
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