Table 6.

Clinical Characteristics, Treatment, and Outcome of Patients With Possible Immune Reconstitution Inflammatory Syndrome

Study Code	Age, Sex, Disease	TNF-α Blocker Treatment		Antifungal Treatment		IRIS Manifestation	Culture, Urine Antigen	Treatment Modification	Outcome
		Drug	Time From Discontinuation to Onset of IRIS	Drug	Duration Prior to Onset of IRIS
1a	66 F Sarcoidosis	Infliximab	10 wk	AMB deoxycholate	7 d	ARDS, reticulonodular infiltrates evolving to bilateral consolidation	8.48 U at diagnosis 4.39 U at IRIS	Corticosteroid	Recovered after 40 d hospitalization
2a	47 M Rheumatoid arthritis	Adalimumab	6 wk	Voriconazole	33 d	Worsening liver function tests	5.55 U at diagnosis 1.77 U at IRIS	Voriconazole changed to fluconazole	Recovered
4a	9 F Juvenile rheumatoid arthritis	Etanercept	1 wk	Liposomal AMB	4 d	Worsening respiratory failure	5.08 ng/mL at diagnosis <0.6 ng/mL at IRIS	None	Recovered
10a	50 M Rheumatoid arthritis	Infliximab	4 wk	AMB deoxycholate	7 d	ARDS, reticulonodular infiltrates evolving to bilateral consolidation	BAL culture positive at presentation Undetectable at IRIS	None	Recovered after 6 wk of mechanical ventilation
11a	62 M Crohn disease	Infliximab	10 wk	AMB	1 d	ARDS, reactive hemophagocytic syndrome	BAL and bone marrow culture positive	Corticosteroid	Recovered after 12 d of mechanical ventilation and 40 d hospitalization
12a	46 F Crohn disease	Infliximab	9 wk	Itraconazole	0	Enlarging lung mass and hilar lymphadenopathy	FNA of lymph node showed reactive inflammation, Ag 4.6 U	None	Recovered
14a	20 F Crohn disease	Infliximab	6 wk	Itraconazole	6 d	ARDS, reticulonodular infiltrates evolving to bilateral consolidation	5.72 ng/mL at diagnosis, 5.21 ng/mL at IRIS	Itraconazole changed to AMB	Recovered after 1 wk mechanical ventilation and 20 d hospitalization
19a	29 F Crohn disease	Adalimumab	4 wk	Itraconazole	12 d	New low-density splenic lesions, hilar lymphadenopathy and pulmonary nodules	10.3 ng/mL at diagnosis, 4.29 ng/mL at IRIS	None	Recovered
20	58 F Rheumatoid arthritis	Etanercept	45 wk	Itraconazole	45 wk	Left supraclavicular lymphadenopathy with biopsy showing granulomatous inflammation and fungal elements	8.46 ng/mL at diagnosis, undetectable at IRIS. Tissue culture no growth	Continued etanercept, prednisone, itraconazole	Recovered

Abbreviations: Ag, antigen; AMB, amphotericin B; ARDS, acute respiratory distress syndrome; BAL, bronchoalveolar lavage fluid; FNA, fine needle aspiration; IRIS, immune reconstitution inflammatory syndrome; TNF, tumor necrosis factor.

^a Previously published [8].