Early Recognition of Immune Reconstitution Inflammatory Syndrome Leads to Avoidance of Endotracheal Intubation

Immune reconstitution inflammatory syndrome occurs in patients with rapidly recovering immune systems in response to antigens (viable pathogens, nonviable pathogen debris, host antigens or tumor antigens). The acronym IRIS, Greek for spectrum of color, is often used for immune reconstitution inflammatory response syndrome and reflects the wide spectrum of clinical manifestations associated with this entity. This is a case report of an acute myelogenous leukemia patient with neutropenia after cytotoxic chemotherapy who developed severe dyspnea and new pulmonary infiltrates temporally associated with rapid neutrophil recovery. The incidence, pathogenesis, clinical presentation and therapy of IRIS will be discussed in this article. There should be an increased awareness of the many clinical manifestations of IRIS in hematologic malignancy patients with rapid neutrophil recovery after cytotoxic chemotherapy, in order to allow prompt institution of corticosteroids which could be life saving.