First Reported Case of Puerperal Immune Reconstitution Inflammatory Syndrome With Multiple Systemic Manifestations in an HIV-Positive Woman: A Case Report and Structured Literature Review.

IntroductionImmune reconstitution inflammatory syndrome (IRIS) is a recognized complication of antiretroviral therapy (ART) in people living with HIV, typically presenting as a single opportunistic infection. Concurrent multisystem IRIS, particularly during the puerperium, is extremely rare.Case PresentationWe report a 27-year-old woman newly diagnosed with HIV during the third trimester of pregnancy who initiated dolutegravir-based ART at 35 weeks' gestation. Three months postpartum, she developed multiple concurrent IRIS manifestations, including oral candidiasis, Kaposi's sarcoma, severe thrombocytopenia, severe anemia, pulmonary embolism, viral pneumonitis, cholangitis, and peripartum cardiomyopathy. Published literature identified very few cases of three or more simultaneous IRIS events after ART initiation, with no previous reports describing such extensive multisystem involvement in the puerperium.ConclusionThis appears to be the first reported puerperal case of extensive multisystem IRIS. We propose the term "IRIS multiplex" to describe patients presenting with five or more concurrent IRIS manifestations, as a hypothesis-generating concept for future research.