Síndrome de reconstitución inmune relacionado con meningitis por Cryptococco en una adolescente infectada con el virus de inmunodeficiencia humana

  • Jorge Quian ASSE, Centro Hospitalario Pereira Rossell, Centro Nacional de Referencia Obstétrico Pediátrico VIH-SIDA. Director. Universidad de la República, Facultad de Medicina, Profesor Agregado de Pediatría
  • Stella Gutiérrez ASSE, Centro Hospitalario Pereira Rossell, Centro Nacional de Referencia Obstétrico Pediátrico VIH-SIDA. Co-Directora. Universidad de la República, Facultad de Medicina, Profesora Agregada de Pediatría
  • Virginia González ASSE, Centro Hospitalario Pereira Rossell, Centro Nacional de Referencia Obstétrico Pediátrico VIH-SIDA. Pediatra. Universidad de la República, Facultad de Medicina, Asistente de Clínica Pediátrica
Palabras clave: SÍNDROME INFLAMATORIO DE RECONSTITUCIÓN INMUNE, MENINGITIS CRIPTOCÓCICA, VIH

Resumen

El síndrome de reconstitución inmune (SIRI) es una complicación del tratamiento del virus de inmunodeficiencia humana (VIH) en pacientes que tenían previamente una alteración profunda de su sistema inmunitario. Se puede presentar bajo dos formas: como SIRI desenmascardor (unmasking syndrom) o paradójico. Se presenta el caso de una adolescente de 13 años en la que se hace diagnóstico de infección por VIH y no se pudo establecer la fuente de contagio. Al momento del diagnóstico, con una inmunosupresión severa se inicia el tratamiento con antirretrovirales y dentro de los dos meses de iniciado es hospitalizada por una meningitis criptocócica. Tratada con anfotericina, evoluciona favorablemente y se logra esterilizar el líquido cefalorraquídeo. Instala nuevamente síndrome de hipertensión endocraneana con elementos de irritación meníngea y convulsiones. Enviada a terapia intensiva se realizan corticoides a altas dosis y mejora, siendo dada de alta. Se interpreta el primer episodio de meningitis criptocócica como un SIRI desenmascarador. Esto es que se pusieron de relieve gérmenes viables pero que su presencia era desconocida. El segundo episodio se interpreta como SIRI paradójico; el hecho de que previamente tuviera el líquido cefalorraquídeo estéril y que mejorara con corticoides y sin antifúngicos corrobora el diagnóstico. El SIRI es un diagnóstico de presunción y no hay elementos de diagnóstico de certeza. Son los datos de la clínica en un paciente VIH inmunosuprimido y en el que se inicia el tratamiento de alta eficacia los que permiten el diagnóstico.

Citas

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Publicado
2012-09-30
Cómo citar
1.
Quian J, Gutiérrez S, González V. Síndrome de reconstitución inmune relacionado con meningitis por Cryptococco en una adolescente infectada con el virus de inmunodeficiencia humana. Rev. Méd. Urug. [Internet]. 30 de septiembre de 2012 [citado 20 de octubre de 2021];28(3):215-20. Disponible en: http://revista.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/343