Department of Dermatology, University of California, San Francisco 94115, USA.
JAMA Dermatol. 2013 Jan;149(1):74-8. doi: 10.1001/2013.jamadermatol.503.
Immune reconstitution inflammatory syndrome (IRIS) is a phenomenon initially described in patients with human immunodeficiency virus. Upon initiation of combination antiretroviral therapy, recovery of cellular immunity triggers inflammation to a preexisting infection or antigen that causes paradoxical worsening of clinical disease. A similar phenomenon can occur in human immunodeficiency virus-negative patients, including pregnant women, neutropenic hosts, solid-organ or stem cell transplant recipients, and patients receiving tumor necrosis factor inhibitors.
We report a case of leprosy unmasking and downgrading reaction after stem cell transplantation that highlights some of the challenges inherent to the diagnosis of IRIS, especially in patients without human immunodeficiency virus infection, as well as review the spectrum of previously reported cases of IRIS reactions in this population.
The mechanism of immune reconstitution reactions is complex and variable, depending on the underlying antigen and the mechanism of immunosuppression or shift in immune status. Use of the term IRIS can aid our recognition of an important phenomenon that occurs in the setting of immunosuppression or shifts in immunity but should not deter us from thinking critically about the distinct processes that underlie this heterogeneous group of conditions.
免疫重建炎症综合征（IRIS）最初在人类免疫缺陷病毒（HIV）患者中描述。在开始联合抗逆转录病毒治疗时，细胞免疫的恢复会引发先前感染或抗原的炎症，导致临床疾病的反常恶化。类似的现象也可能发生在 HIV 阴性患者中，包括孕妇、中性粒细胞减少宿主、实体器官或干细胞移植受者以及接受肿瘤坏死因子抑制剂治疗的患者。
我们报告了一例干细胞移植后麻风病显露和降级反应的病例，该病例突出了诊断 IRIS 所固有的一些挑战，特别是在没有 HIV 感染的患者中，同时还回顾了该人群中先前报道的 IRIS 反应病例的范围。
免疫重建反应的机制复杂且多变，取决于潜在的抗原以及免疫抑制或免疫状态改变的机制。使用 IRIS 这一术语可以帮助我们认识到在免疫抑制或免疫状态改变的情况下发生的一个重要现象，但不应阻止我们对构成这组不同条件的基础过程进行批判性思考。
