Disseminated cryptococcosis in a patient with advanced HIV infection

Antiretroviral therapy in human immunodeficiency virus (HIV) patients has prolonged survival and reduced the frequency of opportunistic infections (OI). However, following starting of antiretroviral therapy (ART), some patients experience a paradoxical worsening of clinical condition termed as immune reconstitution inflammatory syndrome (IRIS) an entity, characterized by an excessive inflammatory response to a preexisting antigen or pathogen. Cryptococcus neoformans is one of the important pathogens that can cause an IRIS, in patients with low CD 4 cell counts in HIV patients. It is important to consider the possibility of cryptococcal infection in patients with advanced HIV infection, look for cryptococcal antigen in serum and cerebrospinal fluid along with blood culture. Blood cultures should be kept for further incubation for slow growing organisms by as demonstrated in the present case. We herewith report a case of IRIS due to cryptococcal meningitis in a patient with HIV1 infection with very low CD4 counts.