Chronic CNS-IRIS without coinfection.

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Presentation transcript:

Chronic CNS-IRIS without coinfection. Chronic CNS-IRIS without coinfection. Two years following the institution of HAART, this HIV-positive patient developed a chronic relapsing and remitting meningitis without detectable organisms. Initial MR imaging on axial FLAIR (A) shows bilateral diffuse deep and subcortical white matter hyperintensities with no atrophy and with high signal in the subarachnoid spaces, while on axial contrast T1WI (B), leptomeningeal enhancement is seen. Minimal brain stem high FLAIR signal is also demonstrated (not shown). Two years later at the time of greatest neurologic impairment, axial FLAIR MR imaging (C) reveals mild mass effect and progression of the supratentorial and brain stem lesions. No organism was detected by CSF analysis. Following brain biopsy and steroid administration, there was symptom resolution. A follow-up MR imaging on axial FLAIR (D) reveals resolution of mass effect and a decrease in white matter lesions. Figures A, C, and D reproduced with permission from Costello et al.77 M.J.D. Post et al. AJNR Am J Neuroradiol 2013;34:1308-1318 ©2013 by American Society of Neuroradiology