The Journal of infectious diseases · 2026
Long-term Outcomes in Previously Healthy non-HIV Individuals with Cryptococcal Meningitis Treated with Pulse-taper Corticosteroids for Post-infectious Inflammatory Syndrome.
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Chang Bickey H, Hargarten Jessica C, Ssebambulidde Kenneth, Scott Terri, Magone M Teresa, Kim H Jeff, Chisholm Jennifer A, Zalewski Chris, Poling Gayla L, Snow Joseph, Billioux Bridgette Jeanne, Cousineau-Krieger Chantal, Bennett John E, Hammoud Dima A, Anjum Seher H, Williamson Peter R
Аннотация
BACKGROUND: Post-infectious inflammatory response syndrome (PIIRS) is an increasingly recognized complication of cryptococcal meningoencephalitis (CM) in non-HIV infected hosts with significant morbidity and mortality. Data describing long-term outcomes following immunomodulatory therapy are limited.
METHODS: We conducted a prospective observational study of 15 immunocompetent adults with CM-PIIRS treated with a pulse corticosteroid taper (PCT) regimen. Performance status, neurocognitive, ophthalmologic, audiologic, and radiologic assessments were performed at greater than one year following CM diagnosis.
RESULTS: After one year, performance status continued to improve from both baseline and the post-pulse periods. Neurocognitive testing revealed mild residual deficits, within the limits of normal, most prominently in information processing and psychomotor speed. Ocular abnormalities were frequent at baseline but showed substantial and sustained reductions following PCT, particularly in retinal nerve fiber layer thickness. Visual field deficits improved by 40% and remained stable thereafter. Evidence for changes in hearing sensitivity at post 1-year follow-up was mixed with 44.5% of ears meeting criteria for improvement, 11% for worsening, and 44.5% being stable. Radiologic abnormalities improved in 79% of patients, although intermittent inflammatory flares occurred during PCT but responded to dose escalation. A prolonged corticosteroid taper may be helpful, and MRI imaging can be used to evaluate response to taper.
CONCLUSIONS: In immunocompetent patients with CM-PIIRS, adjunctive corticosteroid therapy was associated with sustained improvement in neurologic, visual, and radiologic outcomes with mixed improvement in hearing after a year of therapy, with mild residual deficits.
METHODS: We conducted a prospective observational study of 15 immunocompetent adults with CM-PIIRS treated with a pulse corticosteroid taper (PCT) regimen. Performance status, neurocognitive, ophthalmologic, audiologic, and radiologic assessments were performed at greater than one year following CM diagnosis.
RESULTS: After one year, performance status continued to improve from both baseline and the post-pulse periods. Neurocognitive testing revealed mild residual deficits, within the limits of normal, most prominently in information processing and psychomotor speed. Ocular abnormalities were frequent at baseline but showed substantial and sustained reductions following PCT, particularly in retinal nerve fiber layer thickness. Visual field deficits improved by 40% and remained stable thereafter. Evidence for changes in hearing sensitivity at post 1-year follow-up was mixed with 44.5% of ears meeting criteria for improvement, 11% for worsening, and 44.5% being stable. Radiologic abnormalities improved in 79% of patients, although intermittent inflammatory flares occurred during PCT but responded to dose escalation. A prolonged corticosteroid taper may be helpful, and MRI imaging can be used to evaluate response to taper.
CONCLUSIONS: In immunocompetent patients with CM-PIIRS, adjunctive corticosteroid therapy was associated with sustained improvement in neurologic, visual, and radiologic outcomes with mixed improvement in hearing after a year of therapy, with mild residual deficits.