ArticleFrontiers in immunology2026
Individualized immunotherapy for immune reconstitution-associated cortical encephalitis in an HIV-positive cryptococcal meningitis patient: a case report.
Article in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Neurological immune reconstitution inflammatory syndrome (IRIS) in HIV can present variably. We report a case of steroid-dependent, recurrent cortical encephalitis with a distinctive migratory Magnetic Resonance Imaging (MRI) pattern following cryptococcal meningitis. Case presentation: A 38-year-old male with advanced HIV (CD4 11/μL) developed cryptococcal meningitis. After antifungal induction and switching to effective antiretroviral therapy (bictegravir/emtricitabine/tenofovir alafenamide), he suffered recurrent neurological episodes. Serial brain MRIs showed sequentially appearing and resolving T2/Fluid-Attenuated Inversion Recovery (FLAIR) hyperintensities in the bilateral frontal lobes, left cingulate gyrus, and left occipital cortex, despite negative infectious and autoimmune workup. Symptoms were steroid-responsive but relapsed upon tapering. Lasting remission was achieved only after adding mycophenolate mofetil (MMF), allowing corticosteroid withdrawal. Conclusions: This case describes a "migratory cortical encephalitis" phenotype of Central Nervous System (CNS)-IRIS. It highlights that cortical grey matter can be the primary target in severe IRIS and illustrates the utility of steroid-sparing agents like MMF for managing refractory, steroid-dependent neuroinflammation in this context.
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