[Immune reconstitution inflammatory syndrome associated with invasive pulmonary fungal disease]

Immune reconstitution inflammatory syndrome (IRIS) refers to an exaggerated inflammatory response to existing infections or latent pathogens that occurs during rapid immune recovery in immunocompromised hosts, paradoxically leading to clinical deterioration despite appropriate treatment. IRIS is commonly observed in patients with human immunodeficiency virus (HIV)-associated tuberculosis and cryptococcal meningitis after starting antiretroviral therapy. However, it can also occur in immunocompromised individuals without HIV, which remains relatively under-recognized, particularly following neutrophil recovery after chemotherapy for acute leukemia or hematopoietic stem cell transplantation, during the post-operative phase of anti-rejection therapy following solid organ transplantation, or after the rapid reduction or withdrawal of corticosteroids or immunosuppressants, etc. This article summarizes the definition, clinical characteristics, diagnosis, treatment, and prevention of IRIS associated with invasive pulmonary fungal diseases. Clinical management requires accurate identification and careful evaluation to guide optimal and prompt intervention. Appropriate timing of antifungal treatment, initiation of antiretroviral therapy, and adjustment of immunosuppressive agents are crucial to reduce the risk of IRIS and prevent related morbidity and mortality.