Mycoses. 2011 May;54(3):270-2. doi: 10.1111/j.1439-0507.2009.01796.x.
Immune reconstitution syndrome (IRS) is an increasingly common condition that has been described in immunosuppressed individuals once immune function is restored. In this case, we describe a patient who had a renal transplant and subsequently developed pulmonary histoplasmosis. His course was also complicated by the development of a clinical syndrome that was originally attributed to thrombocytopenic thrombotic purpura (TTP). When he did not improve with plasmapheresis and high dose prednisone, a bone marrow biopsy revealed disseminated histoplasmosis and administration of prednisone was rapidly tapered. While on 5 mg of prednisone, he developed an inflammatory syndrome characterised by haemoptysis and respiratory distress, full work-up with pathology was consistent with immune reconstitution syndrome. Treatment for IRS consists of continuing treatment for the underlying infection and consideration of administering anti-inflammatory medication for supportive care. This syndrome should be considered in patients who develop worsening inflammatory symptoms while receiving appropriate treatment for their fungal infection in the setting of restoration of immune function.
免疫重建综合征（IRS）是一种越来越常见的病症，在免疫功能恢复后，免疫抑制个体中已有描述。在本例中，我们描述了一位接受肾移植后发生肺组织胞浆菌病的患者。他的病程还因一种最初归因于血小板减少性血栓性紫癜（TTP）的临床综合征而变得复杂。当他对血浆置换和大剂量泼尼松治疗没有改善时，骨髓活检显示播散性组织胞浆菌病，随后迅速减少泼尼松的剂量。当他服用 5 毫克泼尼松时，出现以咯血和呼吸窘迫为特征的炎症综合征，全面的病理学检查结果与免疫重建综合征一致。IRS 的治疗包括继续治疗基础感染，并考虑给予抗炎药物进行支持性治疗。在免疫功能恢复的情况下，接受适当真菌感染治疗的患者出现炎症症状恶化时，应考虑这种综合征。
