Iglesias Jose, Ledesma Kandria Jumil, Couto Paul J, Liu Jessie
Department of Nephrology, Jersey Shore University Medical Center, Neptune, NJ 07753, USA; Rowan University School of Osteopathic Medicine, Stratford, NJ 08084, USA.
American University of Antigua College of Medicine, Coolidge, Antigua and Barbuda.
Case Rep Transplant. 2017;2017:6290987. doi: 10.1155/2017/6290987. Epub 2017 Mar 7.
Tuberculosis (TB) occurring in solid organ transplantation (SOT) is associated with significant morbidity and mortality usually due to delays in diagnosis, drug toxicity encountered with antimycobacterial therapy, and drug-drug interactions. TB in SOT patients may mimic other infectious and noninfectious posttransplant complications such as posttransplant lymphoproliferative disorder (PTLD) and systemic cytomegalovirus infection. Immune reconstitution inflammatory syndrome (IRIS) is a host response resulting in paradoxical worsening of an infectious disease which occurs after the employment of effective therapy and reversal of an immunosuppressed state. We describe the development of immune reconstitution inflammatory syndrome (IRIS), a unique complication occurring during the treatment of extrapulmonary tuberculosis occurring after transplant which resulted from decreasing immunosuppression in a patient who received Alemtuzumab induction therapy. Although (IRIS) has been originally described in HIV/AIDS patients receiving highly active antiretroviral therapy (HAART), solid organ transplant recipients with diagnosed or occult TB whose immune system may undergo immune reconstitution during their posttransplant course represent a new high risk group.
实体器官移植（SOT）中发生的结核病（TB）通常与显著的发病率和死亡率相关，这通常是由于诊断延迟、抗分枝杆菌治疗中遇到的药物毒性以及药物相互作用所致。SOT患者的结核病可能会模仿其他移植后感染性和非感染性并发症，如移植后淋巴细胞增殖性疾病（PTLD）和全身性巨细胞病毒感染。免疫重建炎症综合征（IRIS）是一种宿主反应，导致在采用有效治疗并逆转免疫抑制状态后，传染病出现反常恶化。我们描述了免疫重建炎症综合征（IRIS）的发生情况，这是一种在移植后发生的肺外结核治疗期间出现的独特并发症，该并发症是由接受阿仑单抗诱导治疗的患者免疫抑制降低所致。尽管（IRIS）最初是在接受高效抗逆转录病毒治疗（HAART）的HIV/AIDS患者中描述的，但诊断为结核病或隐匿性结核病且免疫系统在移植后过程中可能经历免疫重建的实体器官移植受者是一个新的高风险群体。
