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Non–HIV-infected patients with cryptococcal meningitis who receive effective antifungal therapy occasionally develop postinfectious inflammatory response syndrome (PIIRS) despite fungal clearance from the cerebrospinal fluid (CSF). This syndrome is characterized by neurologic deterioration and increased inflammation of the central nervous system. Treatment with corticosteroids has been shown to be helpful in immunocompetent patients. Does it also have a role in immunosuppressed patients?
Researchers prospectively studied 13 patients with cryptococcal meningitis and non–HIV-related immunosuppression who developed PIIRS and were subsequently treated with corticosteroids (median duration, 21 weeks) as well as continued fluconazole.