Cryptococcal lymphadenitis and immune reconstitution inflammatory syndrome: current considerations.

HIV-related immune reconstitution inflammatory syndrome (IRIS) is increasingly being recognized in regions with a high burden of opportunistic infections. We describe an unusual manifestation of IRIS- 'unmasking' cryptococcal lymphadenitis in a patient shortly after initiation of antiretroviral therapy. Epidemiology, clinical features and management of cryptococcal IRIS with reference to lymphadenitis presentation are briefly reviewed. Early and accurate diagnosis is essential for appropriate management. Standard antifungal therapy along with continuation of antiretroviral therapy is recommended. Cases with severe inflammation may benefit from anti-inflammatory drugs/corticosteroids. Unusual manifestations like lymphadenitis pose diagnostic difficulties in regions with a high prevalence of tubercular lymphadenitis.