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Das entzündliche Immunrekonstitutionssyndrom

Immune reconstitution inflammatory syndrome (IRIS)

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Zusammenfassung

Eine überschießende Immunreaktion bei opportunistischen Infektionen wird als inflammatorisches Immunrekonstitutionssyndrom (IRIS) bezeichnet. IRIS wurde hauptsächlich in Assoziation mit HIV-Infektionen beschrieben. Es kommt jedoch auch bei anderen Erkrankungen mit zellulärer Immundefizienz vor. In unserer Klinik haben wir einen Patienten mit IRIS bei M. Whipple behandelt. IRIS tritt häufig nach dem Einsatz der hochaktiven antiretroviralen Therapien (HAART) auf. Bereits kurz nach Beginn der HAART kann eine ausgeprägte Entzündungsreaktion auftreten, welche durch die Wiederherstellung der pathogenspezifischen Immunreaktion ausgelöst wird. Verschiedene infektiöse- bzw. Wirts- sowie Tumorantigene sind möglicherweise verantwortlich für das Auftreten des IRIS. Das IRIS sollte unmittelbar nach Diagnosestellung mit der angemessenen erregerspezifischen Behandlung therapiert werden. Bei schweren Verläufen des IRIS wurde mehrfach die erfolgreiche Therapie mit Glukokortikoiden beschrieben.

Abstract

Overwhelming immune reaction resulting in granulomatous inflammation after infection with opportunistic pathogens has been termed immune reconstitution inflammatory syndrome (IRIS). IRIS has mainly been described in patients with human immunodeficiency virus (HIV). However, IRIS is not restricted to HIV-patients and may occur in other infections and immunodeficiencies. In our clinic, we experienced a Whipple’s disease patient with IRIS. IRIS occurs mainly after initiation of the highly active anti-retroviral therapy (HAART). Soon after HAART initiation, a marked inflammatory reaction can occur, triggered by restoration of pathogen-specific immunity. IRIS may be targeted by various infective antigens, dead or dying infective antigens, host antigens, tumor antigens and other antigens, giving rise to a heterogenous range of clinical manifestations. Treatment should be optimized for the associated condition and initiated immediately. Glucocorticoids should be used in patients who are severely affected by IRIS.

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  1. Abteilung für Nieren- und Hochdruckerkrankungen, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland

    A.D. Wagner

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Wagner, A. Das entzündliche Immunrekonstitutionssyndrom. Z. Rheumatol. 67, 284–289 (2008). https://doi.org/10.1007/s00393-008-0299-0

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