Some patients with Whipple’s disease may develop an inflammatory reconstitution inflammatory syndrome (IRIS) following the initiation of appropriate antibiotic therapy. This can be life-threatening.
Patient selection: Whipple disease following start of antibiotic therapy
Risk factors:
(1) immunosuppression
Clinical features:
(1) The patient has been started on effective antibiotics.
(2) Initially the patients shows mprovement.
(3) Days or weeks later the patient develops fever and inflammation with elevation of CRP and other markers.
(4) Other causes of fever or infection are excluded.
(5) The findings cannot be explained by relapsed or recurrent Whipple disease.
(6) The patient responds to corticosteroids. Some investigators have found therapy with thalidomide to be effective.
The sites of inflammation and its severity determine how serious the IRIS reaction is. Involvement of the eye, brain or heart can significant in some patients.
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