Disseminated Histoplasmosis Associated with the Treatment of Rheumatoid Arthritis with Anticytokine Therapy
Authors: Nina Saksena Asrani
Journal: Annals of Internal Medicine (2008)

Letters21 October 2008Disseminated Histoplasmosis Associated with the Treatment of Rheumatoid Arthritis with Anticytokine TherapyNina Saksena Asrani, MDNina Saksena Asrani, MDFrom Washington University in St. Louis, St. Louis, MO 63130.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-149-8-200810210-00020 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Tumor necrosis factor (TNF)–α antagonists increase risk for opportunistic infection.Objective: To describe a case of disseminated histoplasmosis associated with treatment with adalimumab.Case Report: A 41-year-old white man with rheumatoid arthritis, treated with adalimumab for 9 months, presented for evaluation of 3 weeks of worsening malaise and intermittent fevers. He did not report any joint pain, myalgias, or rash. He subsequently developed progressive dyspnea without cough or chest pain.On physical examination, his temperature was 39.4 °C, and he had tachycardia and tachypnea. His oxygen saturation was 94% on 3 L of oxygen by nasal cannula. He had scleral ...References1. Bongartz T, Sutton AJ, Sweeting MJ, Buchan I, Matteson EL, Montori V. Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies: systematic review and meta-analysis of rare harmful effects in randomized, controlled trials. JAMA. 2006;295:2275-85. [PMID: 16705109] CrossrefMedlineGoogle Scholar2. Giles JT, Bathon JM. Serious infections associated with anticytokine therapies in the rheumatic diseases. J Intensive Care Med. 2004;19:320-34. [PMID: 15523118] CrossrefMedlineGoogle Scholar3. Furst DE, Wallis R, Broder M, Beenhouwer DO. Tumor necrosis factor antagonists: different kinetics and/or mechanisms of action may explain differences in the risk for developing granulomatous infection. Semin Arthritis Rheum. 2006;36:159-67. [PMID: 16884970] CrossrefMedlineGoogle Scholar4. Bakleh M, Tleyjeh I, Matteson EL, Osmon DR, Berbari EF. Infectious complications of tumor necrosis factor-alpha antagonists. Int J Dermatol. 2005;44:443-8. [PMID: 15941429] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Washington University in St. Louis, St. Louis, MO 63130.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byOpportunistic Infections and Autoimmune DiseasesFine-needle aspiration of histoplasmosis in the era of endoscopic ultrasound and endobronchial ultrasoundSafety Updates on Tumor Necrosis Factor BlockersInfectious Complications Associated with Immunomodulating Biologic AgentsInfektionskomplikationen unter Biologika-Therapie bei Patienten mit rheumatoider ArthritisInfectious Complications Associated with Immunomodulating Biologic AgentsA 21-year-old man with Still's disease with fever, rash, and pancytopeniaInvasive Fungal Infections in the Era of Biologics 21 October 2008Volume 149, Issue 8Page: 594-595KeywordsGranulomasHistoplasmosisLungsOpportunistic infectionsOxygenRheumatoid arthritisThoraxUrine ePublished: 21 October 2008 Issue Published: 21 October 2008 Copyright & PermissionsCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...