PDF(Pubmed)
Abstract：
Immune reconstitution inflammatory syndrome (IRIS) describes a constellation of inflammatory symptoms that develop following the initiation of antiretroviral therapy (ART) in patients with advanced human immunodeficiency virus (HIV). Here, we present a case of a 39-year-old male-to-female transgender patient with advanced HIV who was started on ART during a hospitalization for acute encephalopathy due to a combination of methicillin-resistant Staphylococcus aureus (MRSA) meningitis and varicella encephalitis. After adequate treatment of these infections and five weeks after initiation of ART, she developed inflammatory symptoms of malaise, fever, and tachycardia, as well as laboratory findings of leukocytosis consistent with an inflammatory process. Infectious workup did not reveal any evidence of a new infection, and no other undiagnosed inflammatory processes were discovered to explain these symptoms. A diagnosis of IRIS was suspected, possibly induced by a prior varicella infection. Diagnosis of IRIS can be difficult due to heterogeneous symptoms, differing etiologies, variable patient presentations, and the lack of universal diagnostic criteria. As instances of IRIS are not uncommon in patients with a low CD4 count who start on ART, there should be a high index of suspicion when patients present with inflammatory symptoms after initiation of ART. With increased recognition of the disease and improved standardization of diagnostic criteria, more could be understood about the underlying disease process which may allow for better targeted therapies and individualized treatments for patients who develop the immune reconstitution inflammatory syndrome.
摘要：
免疫重建炎症综合征（IRIS）描述了晚期人类免疫缺陷病毒（HIV）患者在抗逆转录病毒治疗（ART）开始后出现的一系列炎症症状。这里,我们介绍了一例39岁男性至女性的晚期HIV变性患者,该患者在因合并耐甲氧西林金黄色葡萄球菌(MRSA)脑膜炎和水痘脑炎导致的急性脑病住院期间开始接受ART治疗.在充分治疗这些感染和开始ART后五周，她出现了不适的炎症症状,发烧,和心动过速,以及实验室发现的白细胞增多与炎症过程一致。传染病检查没有发现任何新感染的证据，没有发现其他未确诊的炎症过程来解释这些症状。怀疑有IRIS的诊断,可能是由先前的水痘感染引起的。由于异质性症状，IRIS的诊断可能很困难，不同的病因，可变的患者介绍，缺乏通用的诊断标准。由于IRIS在开始接受ART的CD4计数低的患者中并不少见，当患者在ART开始后出现炎症症状时,应高度怀疑.随着对该病认识的提高和诊断标准的标准化，对于潜在的疾病过程,我们可以有更多的了解,这些过程可以为发生免疫重建炎症综合征的患者提供更好的靶向治疗和个体化治疗.
