A Case of Cryptococcal Pneumonia in a Rheumatoid Arthritis Patient after Tumor Necrosis Factor-alpha Antagonist Therapy.
10.4078/jkra.2007.14.4.412
- Author:
Seung Min YI
1
;
Mie Jin LIM
;
Seong Ryul KWON
;
Jae Cheon JEONG
;
Jin Soo LEE
;
Su Hyun KWON
;
Lucia KIM
;
Won PARK
Author Information
1. Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea. parkwon@inha.ac.kr
- Publication Type:Case Report
- Keywords:
Rheumatoid arthritis;
Cryptococcal pneumonia;
TNF-alpha blocker
- MeSH:
Aged;
Amphotericin B;
Arthritis, Rheumatoid*;
Biopsy;
Cough;
Crohn Disease;
Cryptococcosis;
Cryptococcus neoformans;
Female;
Fluconazole;
Humans;
Immunity, Cellular;
Infliximab;
Korea;
Leukopenia;
Lung;
Methotrexate;
Pneumonia*;
Prednisolone;
Thorax;
Tumor Necrosis Factor-alpha*;
Yeasts
- From:The Journal of the Korean Rheumatism Association
2007;14(4):412-416
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Tumor necrosis factor-alpha (TNF-alpha) plays a important role in the pathogenesis of rheumatoid arthritis and Crohn's disease, TNF-alpha antagonist has been widely used for these disease, but it also plays a major role in cell mediated immunity. Cryptococcus neoformans, an encapsulated, ubiquitous environmental yeast, is pathogenic for humans, primarily those with compromised immune function. Cryptococcus neoformans is believed to be a facultative intracellular pathogen. We report a case of pulmonary cryptococcosis after chimeric anti-TNF monoclonal antibody therapy. No case has been reported in Korea for the best of our knowledge. A 66-year old woman was admitted because of severe cough. She was diagnosed to have rheumatoid arthritis 4 years ago and taken prednisolone and methotrexate. She was started on infliximab and received ten doses, the last dose being administered 6 weeks prior to above symptom. Chest PA and computed tomography of chest revealed multifocal consolidative lesions in both lungs. Pulmonary cryptococcosis confirmed by thoracoscopic lung biopsy tissue stained with Grocott-Gomori methenamine-silver (GMS). Initially the lung lesion responded to amphotericin B but leukopenia developed after 12 days of treatment. It was changed to fluconazole, then leukopenia and the pneumonia also improved. Physicians should remind pulmonary cryptococcosis in patients receiving TNF-alpha antagonist therapy.
