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• W4387249235 abstract "SESSION TITLE: Chest Infections in Immunocompromised Individuals SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/10/2023 09:40 am - 10:25 am INTRODUCTION: Immune reconstitution inflammatory syndrome (IRIS) is well described in the literature, primarily affecting HIV patients with either the unmasking or paradoxical worsening of a pre-existing infection after starting anti-retroviral therapy. Less commonly, IRIS has been described in non-HIV patients such as those who are immunocompromised in the setting of solid organ transplant, TNF-inhibitors, or neutropenia. Here we describe a never previously reported case of a Systemic Lupus Erythematosus (SLE) patient on chronic home immunosuppression who developed IRIS from Mycobacterium Tuberculosis (TB). CASE PRESENTATION: 49-year-old female, originally from Burma, who had a past medical history of SLE with biopsy proven lupus nephritis, and heart failure with EF recovery. Her home medication regimen included Mycophenolate Mofetil, Prednisone, Dapsone, and Hydroxychloroquine which were started 19 months prior. She presented with progressively worsening weakness, malaise, cough, and night sweats. With the exception of tachypnea, her vitals were stable on room air. Chest x-ray showed diffuse multinodular opacities. Chest CT showed extensive bilateral centrilobular nodularity. Reportedly chest x-ray was negative during immigration 10 years prior. However, she was found to have an indeterminate QuantiFERON Gold 18 months before presentation. Patient was placed in contact precautions and AFBs were obtained with plans for bronchoscopy. Home immunosuppression was held during workup. Roughly 72 hours after presentation, patient had a precipitous decline in clinical status, going from room air to necessitating intubation, four vasopressors, and requiring CRRT for severe refractory acidosis. Despite high dose steroids and empiric RIPE therapy, patient continued to decline and unfortunately passed away. Initial AFB cultures confirmed Mycobacterium Tuberculosis following her passing. DISCUSSION: IRIS in the setting of TB has been described in the literature going back several decades. In HIV patients, IRIS associated TB is reported to transpire 15.7% of the time.[1] A review found that IRIS associated TB in non-HIV patients occurs 2-23% of the time.[2] There is only one reported case of a SLE patient who developed IRIS in the setting of non-tuberculosis mycobacterium that affected the small bowel.[3] We believe our patient's abrupt clinical decline was due to IRIS from holding her home immunosuppression, leading to a robust inflammatory response due to her regained immune system. CONCLUSIONS: With the increasing prevalence of immunosuppressive medications used in both pulmonary and rheumatology practices, we need to be weary of subclinical infections provoking IRIS when immunosuppression therapy is paused. For SLE patients, it may be advised to continue at minimum lower doses of their immunosuppression to avoid IRIS if clinical concern for ongoing Mycobacterium Tuberculosis infection exists. Further research in this area is needed to guide treatment. REFERENCE #1: Müller M, Wandel S, Colebunders R, et al. Immune reconstitution inflammatory syndrome in patients starting antiretroviral therapy for HIV infection: a systematic review and meta-analysis. Lancet Infect Dis. 2010;10(4):251-261. doi:10.1016/S1473-3099(10)70026-8 REFERENCE #2: Lanzafame M, Vento S. Tuberculosis-immune reconstitution inflammatory syndrome. J Clin Tuberc Other Mycobact Dis. 2016;3:6-9. Published 2016 Mar 11. doi:10.1016/j.jctube.2016.03.002 REFERENCE #3: Daum S, Moos V, Loddenkemper C, et al. Immunrekonstitutionssyndrom des Dünndarms bei einer immunsupprimierten Patientin mit systemischem Lupus erythematodes und nichttuberkulöser Mykobakteriose [Immune reconstitution inflammatory syndrome (IRIS) of the small bowel in an immunocompromised patient suffering from systemic lupus erythematosus and non-tuberculous mycobacteriosis]. Z Rheumatol. 2008;67(4):277-283. doi:10.1007/s00393-008-0298-1 DISCLOSURES: No relevant relationships by Carolina Landeen No relevant relationships by Patryk Purta No relevant relationships by Stanley Thomas No relevant relationships by Zachariah Wittenberg" @default.
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• W4387249235 date "2023-10-01" @default.
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• W4387249235 title "RARE CASE OF MYCOBACTERIUM TUBERCULOSIS-ASSOCIATED IMMUNE RECONSTITUTION INFLAMMATORY SYNDROME IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENT ON CHRONIC IMMUNOSUPPRESSION" @default.
• W4387249235 doi "https://doi.org/10.1016/j.chest.2023.07.685" @default.
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