A Case of Invasive Pulmonary Aspergillosis in a Patient with Rheumatoid Arthritis Treated with Adalimumab

Jae Hee Kim; Joong Ki Bae; Jae Wan Jun; Hyun Sung Lee; Hyung Wook Ju; Ji Seon Oh; Seung Won Choi

doi:10.4078/jrd.2011.18.3.212

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Kim, Bae, Jun, Lee, Ju, Oh, and Choi: A Case of Invasive Pulmonary Aspergillosis in a Patient with Rheumatoid Arthritis Treated with Adalimumab

Case Report

J Rheum Dis 2011;18(3):212-215.

Published online: 31 September 2011

DOI: https://doi.org/10.4078/jrd.2011.18.3.212

A Case of Invasive Pulmonary Aspergillosis in a Patient with Rheumatoid Arthritis Treated with Adalimumab

Jae Hee Kim, Joong Ki Bae, Jae Wan Jun, Hyun Sung Lee, Hyung Wook Ju, Ji Seon Oh, Seung Won Choi

Department of Internal Medicine, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan, Korea

Correspondence : Seung Won Choi Department of Internal Medicine, Ulsan University Hospital, College of Medicine, University of Ulsan, 290-3 Jeonha-dong, Dong-gu, Ulsan 682-714, Korea E-mail : choisw@uuh.ulsan.kr

Received 28 February 201113 April 2011 Accepted 17 April 2011

Abstract

We describe a fatal case of invasive pulmonary aspergillosis in a patient with rheumatoid arthritis receiving the TNF-α inhibitor, adalimumab. The use of TNF-α inhibitor has been associated with an increased risk of infections, including tuberculosis and other opportunistic infections. Physicians should have a high index of suspi-cion for opportunistic infection that can develop during TNF-α inhibitor treatment.

Keywords: Invasive aspergillosis, Rheumatoid arthritis, Tumor necrosis factor-alpha

References

1. Crum NF, Lederman ER, Wallace MR. Infections associated with tumor necrosis factor-alpha antagonists. Medicine (Baltimore). 2005; 84:291–302.

2. Giles JT, Bathon JM. Serious infections associated with anticytokine therapies in the rheumatic diseases. J Intensive Care Med. 2004; 19:320–34.

3. Rychly DJ, DiPiro JT. Infections associated with tumor necrosis factor-alpha antagonists. Pharmacotherapy. 2005; 25:1181–92.

4. Tsiodras S, Samonis G, Boumpas DT, Kontoyiannis DP. Fungal infections complicating tumor necrosis factor alpha blockade therapy. Mayo Clin Proc. 2008; 83:181–94.

5. 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.

6. Yi SM, Lim MJ, Kwon SR, Jeong JC, Lee JS, Kwon SH, et al. A case of cryptococcal pneumonia in a rheumatoid arthritis patient after tumor necrosis factor-alpha antagonist therapy. J Korean Rheum Assoc. 2007; 14:412–6.

7. Lee KS, Lee HY, Lee SW, Jung HJ, Song JS. A case of candida bursitis associated with etanercept treatment in a patient with rheumatoid arthritis. J Korean Rheum Assoc. 2008; 15:175–9.

8. Lee EJ, Song R, Park JN, Lee YA, Son JS, Hong SJ, et al. Chronic necrotizing pulmonary aspergillosis in a patient treated with a tumor necrosis factor-alpha inhibitor. Int J Rheum Dis. 2010; 13:e16–9.

9. Listing J, Strangfeld A, Kary S, Rau R, von Hinueber U, Stoyanova-Scholz M, et al. Infections in patients with rheumatoid arthritis treated with biologic agents. Arthritis Rheum. 2005; 52:3403–12.

10. Burmester GR, Mariette X, Montecucco C, Monteagudo-Sáez I, Malaise M, Tzioufas AG, et al. Adalimumab alone and in combination with disease-modifying antirheumatic drugs for the treatment of rheumatoid arthritis in clinical practice: the Research in Active Rheumatoid Arthritis (ReAct) trial. Ann Rheum Dis. 2007; 66:732–9.

11. Kim HO, Kang KY, Ju JH, Kim HY, Park SH. The incidence of serious infection among rheumatoid arthritis patients exposed to tumor necrosis factor antagonists. J Korean Rheum Assoc. 2010; 17:246–53.

12. Soubani AO, Chandrasekar PH. The clinical spectrum of pulmonary aspergillosis. Chest. 2002; 121:1988–99.

13. Warris A, Bj⊘rneklett A, Gaustad P. Invasive pulmonary aspergillosis associated with infliximab therapy. N Engl J Med. 2001; 344:1099–100.

14. Winthrop KL. Risk and prevention of tuberculosis and other serious opportunistic infections associated with the inhibition of tumor necrosis factor. Nat Clin Pract Rheumatol. 2006; 2:602–10.

Figure 1.

Chest radiograph shows no parenchymal lung lesion before the treatment of adalimumab.

Figure 2.

On admission, chest X-ray shows nodular shadow on the left lower lung field (A). Chest CT reveals a 3×3 cm sized nodule in the left lower lobe of the lung with underlying bronchiectasis (B).

Figure 3.

Microscopic examination of lung nodule aspirates shows thin septate hyphae branching at acute angles (H&E, ×400).

Figure 4.

On the 12th day of ad-mission, chest X-ray shows bilateral massive infiltrates (A). Chest CT shows diffuse ground-glass opacifi-cations (B).

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