PMID- 18528698
OWN - NLM
STAT- MEDLINE
DCOM- 20081023
LR  - 20211020
IS  - 0340-1855 (Print)
IS  - 0340-1855 (Linking)
VI  - 67
IP  - 4
DP  - 2008 Jul
TI  - [Immune reconstitution inflammatory syndrome (IRIS) of the small bowel in an 
      immunocompromised patient suffering from systemic lupus erythematosus and 
      non-tuberculous mycobacteriosis].
PG  - 277-8, 280-3
LID - 10.1007/s00393-008-0298-1 [doi]
AB  - An overwhelming immune reaction resulting in granulomatous inflammation after 
      infection with opportunistic pathogens is termed immune reconstitution 
      inflammatory syndrome (IRIS). It has mainly been described in patients with human 
      immunodeficiency virus (HIV) infection on highly active antiretroviral therapy 
      (HAART) who show a significant increase of low CD4 T cells (initially 
      <50/microl). IRIS may lead to organ damage and differential diagnosis is often 
      difficult. We report the case of a 38-year-old female patient who developed a 
      Mycobacteria genavense infection of the liver and the bowel after several 
      immunosuppressive therapies for systemic lupus erythematosus. CD4 T cell counts 
      as low as 17/microl were found and immunosuppressive therapy was stopped. Despite 
      several courses of antibiotic treatment and rising CD4 T cell counts, severe 
      malabsorption persisted. Upper endoscopy revealed a continuous inflammation with 
      pseudopolyps of the small bowel and histologically, a granulomatous infiltrate 
      was detected. After exclusion of a persisting infection by Mycobacteria 
      genavense, IRIS of the small bowel was suspected and treatment with prednisolone 
      was started. The clinical and histological picture improved significantly, the 
      number of CD25(+)CD4(+) cells decreased in the lamina propria of the duodenum 
      under treatment with prednisolone and Foxp3+ regulatory T cells (Treg) 
      accumulated around granulomas. This case shows that IRIS is not restricted to HIV 
      patients but may also occur in otherwise immunosuppressed patients. Due to 
      different treatment strategies, distinguishing IRIS from infectious diseases is 
      essential. The role of Treg in IRIS has to be elucidated.
FAU - Daum, S
AU  - Daum S
AD  - Medizinische Klinik I, Gastroenterologie, Infektiologie und Rheumatologie, 
      Charite-Universitatsmedizin Berlin, Campus Benjamin Franklin, 12200 Berlin, 
      Deutschland. severin.daum@charite.de
FAU - Moos, V
AU  - Moos V
FAU - Loddenkemper, C
AU  - Loddenkemper C
FAU - Schurmann, C
AU  - Schurmann C
FAU - Marker-Hermann, E
AU  - Marker-Hermann E
FAU - Stein, H
AU  - Stein H
FAU - Zeitz, M
AU  - Zeitz M
FAU - Schneider, T
AU  - Schneider T
LA  - ger
PT  - Case Reports
PT  - English Abstract
PT  - Journal Article
TT  - Immunrekonstitutionssyndrom des Dunndarms bei einer immunsupprimierten Patientin 
      mit systemischem Lupus erythematodes und nichttuberkuloser Mykobakteriose.
PL  - Germany
TA  - Z Rheumatol
JT  - Zeitschrift fur Rheumatologie
JID - 0414162
SB  - IM
MH  - Adult
MH  - Enteritis/diagnosis/*immunology
MH  - Female
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/*diagnosis/*immunology
MH  - Immunocompromised Host/*immunology
MH  - Intestine, Small/immunology
MH  - Lupus Erythematosus, Systemic/diagnosis/*immunology
MH  - Mycobacterium Infections/*diagnosis/*immunology/microbiology
EDAT- 2008/06/06 09:00
MHDA- 2008/10/24 09:00
CRDT- 2008/06/06 09:00
PHST- 2008/06/06 09:00 [pubmed]
PHST- 2008/10/24 09:00 [medline]
PHST- 2008/06/06 09:00 [entrez]
AID - 10.1007/s00393-008-0298-1 [doi]
PST - ppublish
SO  - Z Rheumatol. 2008 Jul;67(4):277-8, 280-3. doi: 10.1007/s00393-008-0298-1.