When the Cure Becomes the Problem: A Case Report of Immune Reconstitution Inflammatory Syndrome Associated With Varicella Encephalitis

Immune reconstitution inflammatory syndrome (IRIS) describes a constellation of symptoms that develop following the initiation antiretroviral therapy (ART) in patients with advanced human immunodeficiency virus (HIV). Here, we present case 39-year-old male-to-female transgender patient HIV who was started on ART during hospitalization for acute encephalopathy due to combination methicillin-resistant Staphylococcus aureus (MRSA) meningitis and varicella encephalitis. After adequate treatment these infections five weeks after ART, she developed malaise, fever, tachycardia, as well laboratory findings leukocytosis consistent an process. Infectious workup did not reveal any evidence new infection, no other undiagnosed processes were discovered explain symptoms. A diagnosis IRIS suspected, possibly induced by prior infection. Diagnosis can be difficult heterogeneous symptoms, differing etiologies, variable presentations, lack universal diagnostic criteria. As instances are uncommon low CD4 count start there should high index suspicion when ART. With increased recognition disease improved standardization criteria, more could understood about underlying process which may allow better targeted therapies individualized treatments immune syndrome.