acquiring new OI and developing IRIS again when restarting ART. Prognosis IRIS has a reported mortality rate of 4.5%. Mortality rates vary and depend on the associated OI, degree of immunosuppression, geography, and access to treatment. IRIS affecting the central nervous system has generally been associated with the highest mortality rates (13-75%). History IRIS was discovered in the 1980s when physicians noted paradoxical symptomatic worsening of patients being treated for pulmonary tuberculosis and leprosy. There was worsened fever, weight loss, shortness of breath, and fatigue in patients with pulmonary tuberculosis and worsened skin lesions in patients with leprosy. Though the mechanism was unclear at the time, these observations were attributed to a pro-inflammatory state brought on by starting treatment. In bats recovering from white-nose syndrome Bats recovering from white-nose syndrome (WNS) may be the first known natural occurrence of IRIS, in a report released by the USGS. WNS is typified by a cutaneous infection of the fungus Pseudogymnoascus destructans during hibernation, when the immune system is naturally suppressed to conserve energy through the winter. This study suggests that bats undergoing an intense inflammation at the site of infection after a return to euthermia is a form of IRIS. See also List of cutaneous conditions Jarisch-Herxheimer reaction, another systemic inflammatory syndrome that arises after antimicrobial treatment References Further reading HIV/AIDS Immune system disorders Virus-related cutaneous conditions Syndromes