{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:17:47Z","timestamp":1787026667079,"version":"build-2736575974"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:00:00Z","timestamp":1771804800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>\n                    Immune reconstitution inflammatory syndrome (IRIS) is a serious complication following antiretroviral therapy (ART) initiation in patients with advanced HIV infection, particularly when the central nervous system is involved and multiple opportunistic infections coexist. We report the case of a 26-year-old man with newly diagnosed advanced HIV infection who developed rapid neurological deterioration shortly after ART initiation during hospitalization. Neuroimaging revealed a necrotic central nervous system mass lesion with extensive edema and mass effect. Serological testing demonstrated prior exposure to\n                    <jats:italic>Toxoplasma gondii<\/jats:italic>\n                    and active\n                    <jats:italic>Treponema pallidum<\/jats:italic>\n                    infection. Despite broad antimicrobial therapy, corticosteroids, and supportive care, the patient experienced progressive clinical deterioration and died. Retrospective reassessment of the clinical course, imaging findings, epidemiological context, and treatment response suggested an IRIS-related inflammatory process, with central nervous system tuberculosis\u2013associated IRIS representing the most plausible underlying mechanism, while toxoplasmosis and syphilis were considered potential concomitant or confounding conditions. This case underscores the diagnostic complexity of IRIS in advanced HIV infection and highlights the importance of a cautious, probabilistic, and evidence-based approach to avoid etiologic misclassification in severe neurological presentations.\n                  <\/jats:p>","DOI":"10.3389\/fmed.2026.1742917","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T05:27:18Z","timestamp":1771824438000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Immune reconstitution\u2013related neurological deterioration in advanced HIV infection with multiple opportunistic infections: a diagnostic challenge"],"prefix":"10.3389","volume":"13","author":[{"given":"Jes\u00fas","family":"Endara-Mina","sequence":"first","affiliation":[{"name":"Facultad de Ciencias Jur\u00eddicas y Pol\u00edticas, Universidad T\u00e9cnica Particular de Loja (UTPL)","place":["Loja, Ecuador"]},{"name":"Coordinaci\u00f3n de Docencia e Investigaci\u00f3n, Hospital Provincial General Pablo Arturo Su\u00e1rez, \u00c1ngel Lude\u00f1a s\/n","place":["Quito, Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristopher-Josu\u00e9","family":"Escudero","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias M\u00e9dicas, Universidad Central del Ecuador (UCE)","place":["Quito, Ecuador"]},{"name":"Servicio de Medicina Interna, Hospital de Especialidades Eugenio Espejo","place":["Quito, Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Samaniego","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias M\u00e9dicas, Universidad Central del Ecuador (UCE)","place":["Quito, Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karla","family":"Fuentes","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias de la Salud Eugenio Espejo, Universidad T\u00e9cnica Equinoccial (UTE)","place":["Quito, Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Tapia","sequence":"additional","affiliation":[{"name":"Servicio de Medicina Interna, Hospital de Especialidades Eugenio Espejo","place":["Quito, Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cesar","family":"Intriago","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias M\u00e9dicas, Universidad Central del Ecuador (UCE)","place":["Quito, Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1177\/0022034511399915","article-title":"Immune reconstitution inflammatory syndrome","volume":"23","author":"Tappuni","year":"2011","journal-title":"Adv Dent Res"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1016\/B978-0-444-63849-6.00013-X","article-title":"CNS immune reconstitution inflammatory syndrome","volume":"152","author":"Bowen","year":"2018","journal-title":"Handb Clin Neurol"},{"key":"ref3","first-page":"92","article-title":"Treatment guidelines and prognosis of immune reconstitution inflammatory syndrome patients: a review","volume":"7","author":"Murthy","year":"2015","journal-title":"J Int Oral Health JIOH"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"662","DOI":"10.1038\/nrneurol.2016.149","article-title":"HIV-associated opportunistic CNS infections: pathophysiology, diagnosis and treatment","volume":"12","author":"Bowen","year":"2016","journal-title":"Nat Rev Neurol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1016\/0190-9622(90)70153-9","article-title":"The spectrum of syphilis in patients with human immunodeficiency virus infection","volume":"22","author":"Gregory","year":"1990","journal-title":"J Am Acad Dermatol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1001\/archneur.1993.00540030009006","article-title":"Neurosyphilis. A comparative study of the effects of infection with human immunodefi-ciency virus","volume":"50","author":"Katz","year":"1993","journal-title":"Arch Neurol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1016\/j.jclinepi.2017.04.026","article-title":"CARE guidelines for case reports: explanation and elaboration document","volume":"89","author":"Riley","year":"2017","journal-title":"J Clin Epidemiol"},{"key":"ref8","year":"2025"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1615","DOI":"10.1097\/01.aids.0000131375.21070.06","article-title":"Immune restoration disease after antiretroviral therapy","volume":"18","author":"French","year":"2004","journal-title":"AIDS"},{"key":"ref10","year":"2022"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"ciae479","DOI":"10.1093\/cid\/ciae479","article-title":"Primary care guidance for providers of care for persons with human immunodeficiency virus: 2024 update by the HIV medicine association of the infectious diseases society of America","author":"Horberg","year":"2024","journal-title":"Clin Infect Dis"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1111\/j.1365-3024.2006.00900.x","article-title":"Immune reconstitution disease associated with parasitic infections following antiretroviral treatment","volume":"28","author":"Lawn","year":"2006","journal-title":"Parasite Immunol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1415","DOI":"10.1097\/QAD.0000000000001492","article-title":"Immune reconstitution inflammatory syndrome associated with toxoplasmic encephalitis in HIV-infected patients","volume":"31","author":"WPH","year":"2017","journal-title":"AIDS"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"E65","DOI":"10.3174\/ajnr.A2158","article-title":"Immune reconstitution inflammatory syndrome and cerebral toxo-plasmosis","volume":"31","author":"Cabral","year":"2010","journal-title":"AJNR Am J Neuroradiol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1177\/2325957413488833","article-title":"A rare case of secondary syphilis manifesting as immune reconstitution syndrome in an HIV-positive patient","volume":"12","author":"Vasudevan","year":"2013","journal-title":"J Int Assoc Provid AIDS Care"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"86","DOI":"10.4103\/ijstd.ijstd_110_20","article-title":"Lichenoid secondary syphilis as immune reconstitution inflammatory syndrome with mixed etiology genital ulcer in a human immunodeficiency virus-positive patient","volume":"43","author":"Pangti","year":"2022","journal-title":"Indian J Sex Transm Dis AIDS"},{"key":"ref17","first-page":"226","article-title":"Ocular syphilis in an HIV-infected patient: active disease or immune reconstitution syndrome?","volume":"7","author":"Ceccarelli","year":"2010","journal-title":"HAART Correl Pathol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"2325958219867315","DOI":"10.1177\/2325958219867315","article-title":"HIV-related cerebral toxoplasmosis revisited: current concepts and controversies of an old disease","volume":"18","author":"Vidal","year":"2019","journal-title":"J Int Assoc Provid AIDS Care"},{"key":"ref19","article-title":"Medical Care Criteria Committee","volume-title":"Management of Immune Reconstitution Inflammatory Syndrome (IRIS)","author":"Brust","year":"2024"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1742917\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T05:27:19Z","timestamp":1771824439000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1742917\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,23]]},"references-count":19,"alternative-id":["10.3389\/fmed.2026.1742917"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1742917","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,23]]},"article-number":"1742917"}}