Recognition of immune reconstitution syndrome necessary for better management of patients with severe drug eruptions and those under immunosuppressive therapy

Allergol Int. 2010 Dec;59(4):333-43. doi: 10.2332/allergolint.10-RAI-0260. Epub 2010 Oct 25.

Abstract

The immune reconstitution syndrome (IRS) is an increasingly recognized disease concept and is observed with a broad-spectrum of immunosuppressive therapy-related opportunistic infectious diseases and severe drug eruptions complicated by viral reactivations. Clinical illness consistent with IRS includes tuberculosis, herpes zoster, herpes simples, cytomegalovirus infections and sarcoidosis: thus, the manifestations of this syndrome and diverse and depend on the tissue burden of the preexisting infectious agents during the immunosuppressive state, the nature of the immune system being restored, and underlying diseases of the hosts. Although IRS has originally been reported to occur in the setting of HIV infection, it has become clear that the development of IRS can also be in HIV-negative hosts receiving immunosuppressive agents, such as prednisolone and tumor necrosis factor α inhibitors, upon their reduction and withdrawal. Drug-induced hypersensitivity syndrome, a life-threatening multiorgan system reaction, is another manifestation of the newly observed IRS. Clinical recognition of the IRS is especially important in improving the outcome for diseases with an otherwise life-threatening progenosis. Clinicians should be aware of the implications of IRS and recognize that relieving the symptoms and signs of immune recovery by anti-inflammatory therapies needs to be balanced with anti-microbial therapies aiming at reducing the amplitude and duration of tissue burden of preexisting microbes.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anti-Infective Agents / therapeutic use*
  • Critical Illness
  • Drug Eruptions / complications
  • Drug Eruptions / drug therapy
  • Drug Eruptions / physiopathology
  • HIV Infections / complications
  • HIV Infections / drug therapy
  • HIV Infections / physiopathology
  • Humans
  • Immune Reconstitution Inflammatory Syndrome / chemically induced*
  • Immune Reconstitution Inflammatory Syndrome / complications
  • Immune Reconstitution Inflammatory Syndrome / drug therapy
  • Immune Reconstitution Inflammatory Syndrome / physiopathology
  • Immunosuppressive Agents / adverse effects*
  • Multiple Organ Failure
  • Opportunistic Infections / complications
  • Opportunistic Infections / drug therapy
  • Opportunistic Infections / physiopathology
  • Substance Withdrawal Syndrome*

Substances

  • Anti-Infective Agents
  • Immunosuppressive Agents