Chest
Volume 124, Issue 6, December 2003, Pages 2395-2397
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Selected Reports
Pulmonary Cryptococcosis After Initiation of Anti-Tumor Necrosis Factor-α Therapy

https://doi.org/10.1378/chest.124.6.2395Get rights and content

Many patients with rheumatoid arthritis are being treated with immunosuppressive regimens that include an agent directed at blocking tumor necrosis factor (TNF)-α. Although reportedly safe, tuberculous and fungal infections have emerged as significant complications of therapy. We report a case of pulmonary cryptococcosis soon after the initiation of therapy with the anti–TNF-α antibody, infliximab. A diagnosis was made early in the disease course, and the patient responded quickly to antifungal therapy. This case should alert clinicians to the increased incidence of pulmonary mycoses in patients receiving anti–TNF-α therapy.

Section snippets

Case Report

A 61-year-old man with a 6-year history of advanced rheumatoid arthritis was admitted to the Veterans Affairs hospital for shortness of breath and anemia. His medications included prednisone, 10 mg/d; methotrexate, 25 mg/wk; and leflunomide, 20 mg/d. He was started on infliximab and received three doses at 3 mg/kg ideal body weight, the last dose being administered 3 weeks prior to presentation.

He denied fever, chills, night sweats, chest pain, and weight loss. He denied any sick contacts or

Discussion

The lung is the site of primary infection with C neoformans. Containment and effective control of this infection requires intact host defenses. Immunosuppression can lead to dissemination to the CNS and reticuloendothelial system. In the absence of effective antifungal therapy, immunocompromised patients with pulmonary cryptococcosis are at an increased risk of dissemination with significant morbidity and mortality.4

TNF-α plays a major role in the generation of cell-mediated immunity to

References (12)

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Funding was provided by grant K08 HL04545 to Dr. Knox.

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