Cryptococcal breast abscess in an HIV-positive patient: Arguments for reviewing the definition of immune reconstitution inflammatory syndrome

Atypical manifestations of Cryptococcus neoformons disease have been reported in patients with HIV-1 infection as part of the spectrum of the immune reconstitution inflammatory syndrome (IRIS). We describe a cryptococcal breast abscess in a patient presenting after 11 months of highly active antiretroviral therapy (HAART). The arguments for and against the case being a novel manifestation of IRIS are discussed. The potential hazards of using CD4 count as a surrogate marker of IRIS and the danger of misdiagnosing IRIS as failure of HAART are highlighted. (c) 2008 The British Infection Society. Published by Elsevier Ltd. All rights reserved.