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Immune Reconstitution Inflammatory Syndrome (IRIS)
Miral D. Jhaveri, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Immune reconstitution inflammatory syndrome (IRIS)
              • Synonyms

                • Immune restoration disease (IRD)
                • Immune restitution syndrome (IRS)
              • Definitions

                • Paradoxical worsening of opportunistic infection
                  • After starting highly active antiretroviral therapy (HAART)
                  • Patients with MS, immunomodulatory therapy

              IMAGING

              • General Features

                • CT Findings

                  • MR Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        Selected References

                                        1. Calic Z et al: Treatment of progressive multifocal leukoencephalopathy-immune reconstitution inflammatory syndrome with intravenous immunoglobulin in a patient with multiple sclerosis treated with fingolimod after discontinuation of natalizumab. J Clin Neurosci. ePub, 2014
                                        2. Post MJ et al: CNS-immune reconstitution inflammatory syndrome in the setting of HIV infection, part 1: Overview and discussion of progressive multifocal leukoencephalopathy-immune reconstitution inflammatory syndrome and cryptococcal-immune reconstitution inflammatory syndrome. AJNR Am J Neuroradiol. Epub ahead of print, 2012
                                        3. Post MJ et al: CNS-immune reconstitution inflammatory syndrome in the setting of HIV infection, part 2: Discussion of neuro-immune reconstitution inflammatory syndrome with and without other pathogens. AJNR Am J Neuroradiol. Epub ahead of print, 2012
                                        4. Kranick SM et al: Neurologic complications of HIV-1 infection and its treatment in the era of antiretroviral therapy. Continuum (Minneap Minn). 18(6 Infectious Disease):1319-37, 2012
                                        5. Major EO: Progressive multifocal leukoencephalopathy in patients on immunomodulatory therapies. Annu Rev Med. 61:35-47, 2010
                                        6. Elston JW et al: Immune reconstitution inflammatory syndrome. Int J STD AIDS. 20(4):221-4, 2009
                                        7. McCombe JA et al: Neurologic immune reconstitution inflammatory syndrome in HIV/AIDS: outcome and epidemiology. Neurology. 72(9):835-41, 2009
                                        8. Pepper DJ et al: Neurologic manifestations of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome: a case series. Clin Infect Dis. 48(11):e96-107, 2009
                                        9. Smith AB et al: From the archives of the AFIP: central nervous system infections associated with human immunodeficiency virus infection: radiologic-pathologic correlation. Radiographics. 2008 Nov-Dec;28(7):2033-58. Review. Erratum in: Radiographics. 29(2):638, 2009
                                        10. Sun HY et al: Immune reconstitution inflammatory syndrome in non-HIV immunocompromised patients. Curr Opin Infect Dis. 22(4):394-402, 2009
                                        11. Tan K et al: PML-IRIS in patients with HIV infection: clinical manifestations and treatment with steroids. Neurology. 72(17):1458-64, 2009
                                        12. Tremont-Lukats IW et al: The immune inflammatory reconstitution syndrome and central nervous system toxoplasmosis. Ann Intern Med. 150(9):656-7, 2009
                                        13. Meintjes G et al: Prevention and treatment of the immune reconstitution inflammatory syndrome. Curr Opin HIV AIDS. 3(4):468-76, 2008
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Pathology

                                                • Clinical Issues

                                                  • Diagnostic Checklist

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • Immune reconstitution inflammatory syndrome (IRIS)
                                                    • Synonyms

                                                      • Immune restoration disease (IRD)
                                                      • Immune restitution syndrome (IRS)
                                                    • Definitions

                                                      • Paradoxical worsening of opportunistic infection
                                                        • After starting highly active antiretroviral therapy (HAART)
                                                        • Patients with MS, immunomodulatory therapy

                                                    IMAGING

                                                    • General Features

                                                      • CT Findings

                                                        • MR Findings

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Gross Pathologic & Surgical Features

                                                                  • Microscopic Features

                                                                    CLINICAL ISSUES

                                                                    • Presentation

                                                                      • Demographics

                                                                        • Natural History & Prognosis

                                                                          • Treatment

                                                                            DIAGNOSTIC CHECKLIST

                                                                            • Consider

                                                                              Selected References

                                                                              1. Calic Z et al: Treatment of progressive multifocal leukoencephalopathy-immune reconstitution inflammatory syndrome with intravenous immunoglobulin in a patient with multiple sclerosis treated with fingolimod after discontinuation of natalizumab. J Clin Neurosci. ePub, 2014
                                                                              2. Post MJ et al: CNS-immune reconstitution inflammatory syndrome in the setting of HIV infection, part 1: Overview and discussion of progressive multifocal leukoencephalopathy-immune reconstitution inflammatory syndrome and cryptococcal-immune reconstitution inflammatory syndrome. AJNR Am J Neuroradiol. Epub ahead of print, 2012
                                                                              3. Post MJ et al: CNS-immune reconstitution inflammatory syndrome in the setting of HIV infection, part 2: Discussion of neuro-immune reconstitution inflammatory syndrome with and without other pathogens. AJNR Am J Neuroradiol. Epub ahead of print, 2012
                                                                              4. Kranick SM et al: Neurologic complications of HIV-1 infection and its treatment in the era of antiretroviral therapy. Continuum (Minneap Minn). 18(6 Infectious Disease):1319-37, 2012
                                                                              5. Major EO: Progressive multifocal leukoencephalopathy in patients on immunomodulatory therapies. Annu Rev Med. 61:35-47, 2010
                                                                              6. Elston JW et al: Immune reconstitution inflammatory syndrome. Int J STD AIDS. 20(4):221-4, 2009
                                                                              7. McCombe JA et al: Neurologic immune reconstitution inflammatory syndrome in HIV/AIDS: outcome and epidemiology. Neurology. 72(9):835-41, 2009
                                                                              8. Pepper DJ et al: Neurologic manifestations of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome: a case series. Clin Infect Dis. 48(11):e96-107, 2009
                                                                              9. Smith AB et al: From the archives of the AFIP: central nervous system infections associated with human immunodeficiency virus infection: radiologic-pathologic correlation. Radiographics. 2008 Nov-Dec;28(7):2033-58. Review. Erratum in: Radiographics. 29(2):638, 2009
                                                                              10. Sun HY et al: Immune reconstitution inflammatory syndrome in non-HIV immunocompromised patients. Curr Opin Infect Dis. 22(4):394-402, 2009
                                                                              11. Tan K et al: PML-IRIS in patients with HIV infection: clinical manifestations and treatment with steroids. Neurology. 72(17):1458-64, 2009
                                                                              12. Tremont-Lukats IW et al: The immune inflammatory reconstitution syndrome and central nervous system toxoplasmosis. Ann Intern Med. 150(9):656-7, 2009
                                                                              13. Meintjes G et al: Prevention and treatment of the immune reconstitution inflammatory syndrome. Curr Opin HIV AIDS. 3(4):468-76, 2008