A woman undergoes immunosuppression during pregnancy, which reverses in the postpartum period. As immunity recovers the woman may develop an Immune Reconstitution Syndrome (IRS).


The immune reconstitution may be manifested as:

(1) onset or exacerbation of a quiescent or latent infection

(2) onset or exacerbation of an autoimmune disease

(3) onset or exacerbation of a disease with an immune component


Infections that have been associated with an IRS following delivery:

(1) tuberculosis or other mycobacterial disease

(2) deep fungal infection (cryptococcosis, coccidioidomycosis, etc)

(3) chronic viral hepatitis B or C

(4) herpesvirus

(5) anogenital warts


Autoimmune diseases that have shown IRS following delivery include:

(1) rheumatoid arthritis

(2) Graves's disease

(3) SLE


Diseases with an immune component the may show IRS following delivery:

(1) multiple sclerosis

(2) sarcoidosis

(3) hemolytic uremic syndrome


Some conditions (such as Guillain-Barre Syndrome) may worsen during pregnancy, only to improve following delivery.


The diagnosis requires exclusion of another causes, such as change in corticosteroid therapy or immunosuppression.


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