Long-term outcomes after corticosteroids for cryptococcal meningitis–associated inflammatory syndrome

Post-infectious inflammatory response syndrome (PIIRS) can complicate cryptococcal meningoencephalitis in people without HIV, but long-term outcomes after immunomodulatory treatment remain poorly characterized. A prospective observational study assessed 15 immunocompetent adults with cryptococcal meningitis–associated PIIRS treated with a pulse corticosteroid taper regimen. Performance status, neurocognitive function, vision, hearing, and radiologic findings were evaluated more than one year after diagnosis.

Performance status continued to improve relative to both baseline and the immediate post-pulse period. Neurocognitive testing identified mild residual deficits, within normal limits, particularly in information processing and psychomotor speed. Baseline ocular abnormalities showed sustained reductions, notably in retinal nerve fiber layer thickness. Visual field deficits improved by 40% and subsequently remained stable. Hearing sensitivity improved in 44.5% of ears, worsened in 11%, and remained stable in 44.5%. Radiologic abnormalities improved in 79% of patients. Intermittent inflammatory flares during the taper responded to corticosteroid dose escalation.

The findings suggest sustained improvement across several domains after adjunctive corticosteroid treatment, although hearing recovery was inconsistent. The authors suggest that prolonged tapering may help and that MRI can support assessment during tapering. The small observational cohort and absence of a comparator described in the abstract limit causal inference. Full-text details were unavailable for assessment.