PMID- 38022239
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20231201
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 15
IP  - 10
DP  - 2023 Oct
TI  - Paradoxical Immune Reconstitution Inflammatory Syndrome in SARS-CoV-2 Infection 
      After Improvement of Chemotherapy-Induced Aplasia.
PG  - e46723
LID - 10.7759/cureus.46723 [doi]
LID - e46723
AB  - Severe coronavirus disease 2019 (COVID-19) is known to manifest in two phases, 
      with a potential worsening in the second week. The pathophysiology of the first 
      phase is expected to be heavily influenced by viral replication while the second 
      phase is thought to be primarily characterized by systemic inflammation. We 
      present the case of a 42-year-old man hospitalized for severe acute respiratory 
      syndrome coronavirus 2 (SARS-CoV-2) infection with a history of 
      Philadelphia-positive chronic myeloid leukemia, diagnosed seven months earlier, 
      proposed to bone marrow allotransplantation after refractory imatinib and 
      dasatinib treatment. After an initial clinical and laboratory improvement, the 
      patient got worse. A pulmonary CT scan showed worsening ground-glass opacities 
      and multiple bilateral consolidations. Neutropenia was resolved, and on the same 
      day, the patient developed progressive respiratory failure with rapidly 
      increasing oxygen demand and distributive shock, requiring mechanical 
      ventilation. Acute respiratory distress syndrome (ARDS) induced by paradoxical 
      COVID-19 immune reconstitution inflammatory syndrome (IRIS) following 
      chemotherapy-induced aplasia was equated. High-dose corticosteroid therapy was 
      rapidly effective. IRIS occurs in patients with severe immunosuppression in 
      response to rapid immune reconstitution and results in an uncontrolled 
      inflammatory response to infectious agents that cause tissue damage. The 
      inflammation associated with both IRIS and COVID-19 shares a common path in terms 
      of immunological response. We hypothesize that in our patient, a 
      hyperinflammation overlap exerted a synergistic effect, leading to the worsening 
      of the disease.
CI  - Copyright (c) 2023, Canelas Mendes et al.
FAU - Canelas Mendes, Cristiana
AU  - Canelas Mendes C
AD  - Internal Medicine 2, Hospital Santa Maria, Centro Hospitalar Universitario Lisboa 
      Norte, Lisboa, PRT.
FAU - Howell Monteiro, Patricia
AU  - Howell Monteiro P
AD  - Internal Medicine 2, Hospital Santa Maria, Centro Hospitalar Universitario Lisboa 
      Norte, Lisboa, PRT.
FAU - Madeira Lopes, Joao
AU  - Madeira Lopes J
AD  - Internal Medicine 2, Hospital Santa Maria, Centro Hospitalar Universitario Lisboa 
      Norte, Lisboa, PRT.
FAU - Pais de Lacerda, Antonio
AU  - Pais de Lacerda A
AD  - Internal Medicine 2, Hospital Santa Maria, Centro Hospitalar Universitario Lisboa 
      Norte, Lisboa, PRT.
LA  - eng
PT  - Case Reports
DEP - 20231009
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC10631116
OTO - NOTNLM
OT  - ards
OT  - chemotherapy-induced aplasia
OT  - covid-19
OT  - immunosuppression
OT  - iris
COIS- The authors have declared that no competing interests exist.
EDAT- 2023/11/29 18:43
MHDA- 2023/11/29 18:44
PMCR- 2023/10/09
CRDT- 2023/11/29 15:19
PHST- 2023/10/09 00:00 [accepted]
PHST- 2023/11/29 18:44 [medline]
PHST- 2023/11/29 18:43 [pubmed]
PHST- 2023/11/29 15:19 [entrez]
PHST- 2023/10/09 00:00 [pmc-release]
AID - 10.7759/cureus.46723 [doi]
PST - epublish
SO  - Cureus. 2023 Oct 9;15(10):e46723. doi: 10.7759/cureus.46723. eCollection 2023 
      Oct.