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Case Reports
. 2017 Jan 13;17(1):70.
doi: 10.1186/s12879-016-2097-7.

Concomitant disseminated histoplasmosis and disseminated tuberculosis after tumor necrosis factor inhibitor treatment: a case report

Juan E Muñoz-Oca  1 , Martha L Villarreal Morales  2 , Aracelis Nieves-Rodriguez  3 , Lemuel Martínez-Bonilla  4
Affiliations
Case Reports

Concomitant disseminated histoplasmosis and disseminated tuberculosis after tumor necrosis factor inhibitor treatment: a case report

Juan E Muñoz-Oca et al. BMC Infect Dis. .

Abstract

Background: Tumor necrosis factor antagonist inhibitors have transformed the approach to patients with severe autoimmune conditions, such as rheumatoid arthritis. Although the therapy can be highly effective, TNF-α inhibitors are associated with an increased risk of opportunistic infections.

Case presentation: Here, we report a case of concomitant disseminated histoplasmosis and tuberculosis in a 65-year-old female with rheumatoid arthritis treated with TNF-α inhibitor. Both conditions can be found in disseminated form in immunosuppressed hosts, but co-infection is rare with only a few cases having been reported, to our knowledge, all in HIV patients.

Conclusions: This case posed a considerable challenge for diagnosis and treatment due to the unusual disseminated co-infection, the overlapping symptoms, and the interactions between medications.

Keywords: Adalimumab; Case report; Co-infection; Histoplasmosis; TNF-α inhibitors; Tuberculosis.

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Figures

Fig. 1
Fig. 1
a Axial CT abdomen image demonstrates numerous hypo-attenuating lesions on spleen, almost replacing the normal parenchyma. b Axial CT chest image reveling reticulonodular infiltrates with tree in bud and cavitations
See this image and copyright information in PMC

References

    1. Anstead GM, Patterson TF. Endemic mycoses. In: Anaissie EJ, McGinnis MR, Pfaller MA, editors. Clinical mycology. 2. Philadelphia, PA: Churchill Livingstone Elsevier; 2009. pp. 355–373.
    1. World Health Organization . Global tuberculosis report. 2015.
    1. Verrall AJ, Netea MG, Alisjahbana B, Hill PC, van Crevel R. Early clearance of Mycobacterium tuberculosis: a new frontier in prevention. Immunology. 2014;141:506–513. doi: 10.1111/imm.12223. - DOI - PMC - PubMed
    1. Agudelo CA, Restrepo CA, Molina DA, et al. Tuberculosis and histoplasmosis co-infection in AIDS patients. Am J Trop Med Hyg. 2012;87:1094–1098. doi: 10.4269/ajtmh.2012.12-0292. - DOI - PMC - PubMed
    1. US Food and Drug Administration. Information for healthcare professionals: cimzia (certolizumab pegol), enbrel (etanercept), humira (adalimumab), and remicade (infliximab). Available at: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPa.... Accessed: 16 Apr 2015.

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