Immune reconstitution inflammatory syndrome in the lung in non-human immunodeficiency virus patients.

Abstract

We evaluated immune reconstitution inflammatory syndrome (IRIS) in the lung in non-human immunodeficiency virus (HIV) patients. We reviewed articles related to IRIS occurrence in the lung in non-HIV patients using a PubMed search. The keywords used for the search were "immune reconstitution syndrome" and "non-HIV." Only patients with lung involvement were included. Those with suggested IRIS caused by white blood cell recovery were excluded. There were 37 cases of IRIS in the lung in non-HIV patients. Complicating infections included tuberculosis (n=17), histoplasmosis (n=9), aspergillosis (n=5), cryptococcosis (n=4), and Pneumocystis pneumonia (n=2). We also evaluated the underlying diseases, IRIS pathogenesis, management, and prognosis. IRIS was most commonly encountered in patients treated with anti-tumor necrosis factor (TNF) antibody who developed disseminated or extrapulmonary tuberculosis, leading to treatment discontinuation. The diagnosis and management of IRIS in the lung in non-HIV patients should be investigated further, especially in the era of anti-TNF treatment.