Journal List > J Rheum Dis > v.18(3) > 1063916

Lee, Kwon, Min, Hur, Kim, Kim, and Lee: A Case of Pulmonary Cryptococcosis in a Patient with Psoriatic Arthritis Treated with Adalimumab

Abstract

Psoriatic arthritis is an immune-mediated chronic inflammatory disease triggered and maintained by inflammatory mediators, including tumor necrosis factor-α. Although TNF-α antagonist is effective for the treatment of psoriatic arthritis, infections caused by tuberculosis or fungus have emerged as significant complications of therapy. We report a case of pulmonary cryptococcosis in a patient with psoriatic arthritis treated with adalimumab.

References

1. Robinson WH, Genovese MC, Moreland LW. Demyeli-nating and neurologic events reported in association with tumor necrosis factor alpha antagonism: by what mechanisms could tumor necrosis factor alpha antagonists im-prove rheumatoid arthritis but exacerbate multiple sclerosis? Arthritis Rheum. 2001; 44:1977–83.
2. Cadena J, Thompson GR 3rd, Ho TT, Medina E, Hughes DW, Patterson TF. Immune reconstitution inflammatory syndrome after cessation of the tumor necrosis factor alpha blocker adalimumab in cryptococcal pneumonia. Diagn Microbiol Infect Dis. 2009; 64:327–30.
3. Fantuzzi F, Del Giglio M, Gisondi P, Girolomoni G. Targeting tumor necrosis factor alpha in psoriasis and psoriatic arthritis. Expert Opin Ther Targets. 2008; 12:1085–96.
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. Smith JA. Tumor Necrosis Factor Inhibitors and Fungal Infections. Curr Fungal Infect Rep. 2010; 4:38–45.
crossref
6. Salmon-Ceron D, Tubach F, Lortholary O, Chosidow O, Bretagne S, Nicolas N, et al. Drug-specific risk of non-tuberculosis opportunistic infections in patients receiving anti-TNF therapy reported to the 3-year prospective French RATIO registry. Ann Rheum Dis. 2011; 70:616–23.
crossref
7. Thavarajah K, Wu P, Rhew EJ, Yeldandi AK, Kamp DW. Pulmonary complications of tumor necrosis factor-tar-geted therapy. Respir Med. 2009; 103:661–9.
crossref
8. Kuykendall SJ, Ellis FH Jr, Weed LA, Donoghue FE. Pulmonary cryptococcosis. N Engl J Med. 1957; 257:1009–16.
crossref
9. Steinbrocker O, Traeger CH, Batterman RC. Therapeutic criteria in rheumatoid arthritis. J Am Med Assoc. 1949; 140:659–62.
crossref
10. Lewis JL, Rabinovich S. The wide spectrum of cryptococcal infections. Am J Med. 1972; 53:315–22.
crossref
11. Warr W, Bates JH, Stone A. The spectrum of pulmonary cryptococcosis. Ann Intern Med. 1968; 69:1109–16.
crossref
12. Eng RH, Bishburg E, Smith SM, Kapila R. Cryptococcal infections in patients with acquired immune deficiency syndrome. Am J Med. 1986; 81:19–23.
crossref
13. Hammerman KJ, Powell KE, Christianson CS, Huggin PM, Larsh HW, Vivas JR, et al. Pulmonary cryptococcosis: clinical forms and treatment. A Center for Disease Control cooperative mycoses study. Am Rev Respir Dis. 1973; 108:1116–23.
14. Perfect JR, Dismukes WE, Dromer F, Goldman DL, Graybill JR, Hamill RJ, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america. Clin Infect Dis. 2010; 50:291–322.
crossref
15. Iida M, Ohmori K, Kitamura K, Muramatsu T, Nagasaka F, Haga N, et al. Primary pulmonary cryptococcosis treated by thoracoscopic resection. Nihon Kyobu Shikkan Gakkai Zasshi. 1996; 34:575–8.

Figure 1.
(A) Nodular opacity was noted in left lower lung at the time of admission. (B) Chest CT revealed the consolidations in left lower lung.
jrd-18-216f1.tif
Figure 2.
(A) Microscopically, chronic granulomatous inflammation with multinucleated giant cells are noted (×100). (B) Microscopic appearance of cryptococcosis in methenamine silver stain. The 5∼10 μm cryptococcal yeast has a highly characteristic thick capsule (×1,000).
jrd-18-216f2.tif
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