TITLE:
Immune Reconstitution Inflammatory Syndrome Unmasking Cerebral Toxoplasmosis after Restarting Dolutegravir-Based Antiretroviral Therapy: A Case Report and Mini-Review
AUTHORS:
Martin Herbas Ekat, Tatia Adoua Doukaga, Gilius Axel Aloumba, Médard Amona, Bienvenu Rolland Ossibi Ibara
KEYWORDS:
IRIS, Toxoplasmosis, Dolutegravir
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.15 No.10,
September
30,
2026
ABSTRACT: A 42-year-old woman living with HIV, who had been off antiretroviral therapy for two years, restarted a dolutegravir-based regimen with a baseline plasma viral load of 120,000 copies/mL and a CD4 T-lymphocyte count of 64 cells/mm3. Two months later, despite complete virological suppression and a CD4 count of 201 cells/mm3, she developed headache, seizures, and a motor deficit. Cranial computed tomography (CT) revealed ring-enhancing lesions suggestive of cerebral toxoplasmosis. The timing of events and the rapid virological response led to a diagnosis of immune reconstitution inflammatory syndrome (IRIS) unmasking cerebral toxoplasmosis. The outcome was favourable with co-trimoxazole, corticosteroid therapy, and continuation of antiretroviral therapy. This case highlights the importance of considering IRIS in patients presenting with neurological manifestations after initiation or resumption of effective antiretroviral therapy.