title: Immune reconstitution inflammatory syndrome in neutropenic patients with invasive pulmonary aspergillosis.
abstract: OBJECTIVE
  Clinical and radiologic deterioration is sometimes observed during neutrophil recovery in patients with invasive pulmonary aspergillosis (IPA). This deterioration can be caused by immune reconstitution inflammatory syndrome (IRIS) as well as by progression of the IPA. However, there is limited data on IRIS in neutropenic patients.
  
  
  METHODS
  Over a 6-year period, adult patients with neutropenia who met the criteria for probable or proven IPA by the revised EORTC/MSG definition were retrospectively enrolled. IRIS was defined as de novo appearance or worsening of radiologic pulmonary findings temporally related to neutrophil recovery, with evidence of a decrease of 50% in serum galactomannan level.
  
  
  RESULTS
  Of 153 patients, 36 (24%, 95% CI 18%-31%) developed IRIS during neutrophil recovery. More of these patients received voriconazole than did those with non-IRIS (42% vs. 25%, P = 0.05). Thirty- and ninety-day mortalities were lower in the patients with IRIS than in those with non-IRIS (11% vs. 33%, P = 0.01, and 33% vs. 58%, P = 0.01, respectively).
  
  
  CONCLUSIONS
  IRIS is relatively common among neutropenic patients with IPA, occurring in about one quarter of such patients. It is associated with voriconazole use and has a good prognosis.
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, University of Ulsan, Seoul, Republic of Korea.
authors.forename: Jiwon
authors.initials: J
authors.lastname: Jung
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Republic of Korea.
authors.forename: Hyo-Lim
authors.initials: HL
authors.lastname: Hong
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, University of Ulsan, Seoul, Republic of Korea.
authors.forename: Sang-Oh
authors.initials: SO
authors.lastname: Lee
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, University of Ulsan, Seoul, Republic of Korea.
authors.forename: Sang-Ho
authors.initials: SH
authors.lastname: Choi
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, University of Ulsan, Seoul, Republic of Korea.
authors.forename: Yang Soo
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, University of Ulsan, Seoul, Republic of Korea.
authors.forename: Jun Hee
authors.initials: JH
authors.lastname: Woo
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, University of Ulsan, Seoul, Republic of Korea. Electronic address: kimsunghanmd@hotmail.com.
authors.forename: Sung-Han
authors.initials: SH
authors.lastname: Kim
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D005260:Female; D005690:Galactose / Q000031:analogs & derivatives; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000150:complications* / Q000401:mortality; D055744:Invasive Pulmonary Aspergillosis / Q000150:complications* / Q000401:mortality; D008168:Lung / Q000473:pathology; D008297:Male; D008351:Mannans / Q000097:blood; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications*; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D065819:Voriconazole / Q000627:therapeutic use*
chemical_list: D000935:Antifungal Agents; D008351:Mannans; C012990:galactomannan; D065819:Voriconazole; D005690:Galactose
keywords: Immune reconstitution inflammatory syndrome; Invasive pulmonary aspergillosis; Neutropenia