Immune Reconstitution Inflammatory Syndrome Following Remission of Cushing’s Syndrome and Review of Literature

Abstract

The current study aims to report cases of immune reconstitution inflammatory syndrome (IRIS) following Cushing’s syndrome (CS) treatment and elucidate various presentations of IRIS and its management. A single-centre study was conducted in individuals with endogenous CS who presented with immune reconstitution inflammatory syndrome after CS remission. A literature review was also conducted to describe the previous reporting of IRIS. Nine cases from the author’s centre were identified. Out of 9 cases, one case was ectopic CS, who presented with CNS vasculitis following excision of the primary lesion. Other 8 cases were Cushing’s disease (CD) presented with diverse IRIS manifestations in the form of thyroiditis, oculomotor neuritis, extraocular muscle palsy, episcleritis, bell’s palsy, rheumatoid arthritis (RA) and Charcot neuroarthropathy, with the time of presentation from less than 1 month till 24 months. The most common IRIS described in the literature is thyroid dysfunction, and the time of presentation of IRIS is variable from less than one month to 5 years. Immune reconstitution inflammatory syndrome is a unique and rare post-operative complication after CS remission, affecting various organ systems due to rebound immunity.

Keywords

• autoimmune dysfunction
• cushing’s syndrome
• immune reconstitution inflammatory syndrome