02066nas a2200241   4500000000100000008004100001260001500042653001400057653001200071653005500083653003300138100001900171700001500190700001600205700001400221700001600235700001400251245013400265300000900399490000800408520139400416022001401810       2013                            d  c2013 Jan 110aReactions10aleprosy10aImmune reconstitution inflammatory syndrome (IRIS)10aHuman immunodeficiency virus1 aScharschmidt T1 aAmerson EH1 aRosenberg O1 aJacobs RA1 aMcCalmont T1 aShinkai K00aImmune reconstitution reactions in human immunodeficiency virus-negative patients: report of a case and review of the literature.  a74-80 v1493 aBACKGROUND Immune reconstitution inflammatory syndrome (IRIS) is a phenomenon initially described in patients with human immunodeficiency virus. Upon initiation of combination antiretroviral therapy, recovery of cellular immunity triggers inflammation to a preexisting infection or antigen that causes paradoxical worsening of clinical disease. A similar phenomenon can occur in human immunodeficiency virus-negative patients, including pregnant women, neutropenic hosts, solid-organ or stem cell transplant recipients, and patients receiving tumor necrosis factor inhibitors. OBSERVATIONS We report a case of leprosy unmasking and downgrading reaction after stem cell transplantation that highlights some of the challenges inherent to the diagnosis of IRIS, especially in patients without human immunodeficiency virus infection, as well as review the spectrum of previously reported cases of IRIS reactions in this population. CONCLUSIONS The mechanism of immune reconstitution reactions is complex and variable, depending on the underlying antigen and the mechanism of immunosuppression or shift in immune status. Use of the term IRIS can aid our recognition of an important phenomenon that occurs in the setting of immunosuppression or shifts in immunity but should not deter us from thinking critically about the distinct processes that underlie this heterogeneous group of conditions.  a2168-6084