Neurologic consequences of the immune reconstitution inflammatory syndrome (IRIS)

Although major advancements have been made in the treatment of HIV infection, graft-versus-host reactions, and autoimmune diseases, an unexpected consequence of treatment has been the emergence of a devastating inflammatory syndrome, termed the immune reconstitution inflammatory syndrome (IRIS). The pathophysiology of the syndrome is poorly understood, and the syndrome poses unique challenges for diagnosis and treatment. We have reviewed the neurologic manifestations of IRIS in the context of HIV infection as well as in the setting of treatment of autoimmune diseases such as multiple sclerosis, in which compartmental immune suppression may occur without an obvious underlying immune suppression. The purpose of this review is to identify common themes that may assist in the diagnosis and management of these IRIS syndromes.