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Review
. 2023 Jun 18;9(6):683.
doi: 10.3390/jof9060683.

Recurrent Scedosporium apiospermum Cutaneous Infection in a Patient with Rheumatoid Arthritis: The Potent Role of IL-6 Signaling Pathway Blockade: A Case-Based Review

Antigone Pieta  1 , Aliki I Venetsanopoulou  1 , Christos Kittas  2 , Eirini Christaki  3 , Paraskevi V Voulgari  1
Affiliations
Review

Recurrent Scedosporium apiospermum Cutaneous Infection in a Patient with Rheumatoid Arthritis: The Potent Role of IL-6 Signaling Pathway Blockade: A Case-Based Review

Antigone Pieta et al. J Fungi (Basel). .

Abstract

Rheumatoid arthritis (RA) patients deal with a higher risk of bacterial and fungal infections compared to the general population because of their dysregulated immune system as well as the immunosuppressive therapy they usually receive. Scedosporium spp. is a fungal pathogen responsible for cutaneous, lung, central nervous system, and eye infections, mostly in immunocompromised patients, leading to death in disseminated cases. We report the case of an 81-year-old woman with rheumatoid arthritis treated with steroids and an IL-6 inhibitor who was diagnosed with scedosporiosis of the upper limb. She was treated with voriconazole for one month, which was discontinued due to adverse events, and when scedosporiosis relapsed, she switched to itraconazole. We also reviewed the current literature on RA patients presenting with Scedosporium infections. Early and accurate diagnosis of scedosporiosis has therapeutic and prognostic implications, as traditionally this fungus is resistant to commonly used antifungals. Clinical alertness regarding uncommon infections, including fungal, in patients with autoimmune diseases on immunomodulatory agents is essential for effective treatment.

Keywords: IL-6 inhibitor; Scedosporium apiospermum; fungal infection; immunosuppression; rheumatoid arthritis.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1
Figure 1
(a) Swelling of the patient’s right hand at clinical evaluation, (b) Musculoskeletal ultrasound demonstrating a cyst (white arrow) and severe tenosynovitis with present Power Doppler (yellow arrow), (c) Patient’s right hand at discharge.
Figure 2
Figure 2
Recurrence of scedosporiosis on the patient’s right hand.
Figure 3
Figure 3
Methodology flowchart.
See this image and copyright information in PMC

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