A Case of Cryptococcal Pneumonia in a Rheumatoid Arthritis Patient after Tumor Necrosis Factor-alpha Antagonist Therapy / 대한류마티스학회지
The Journal of the Korean Rheumatism Association
;
: 412-416, 2007.
Article
in Korean
| WPRIM
| ID: wpr-227630
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.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Pneumonia
/
Arthritis, Rheumatoid
/
Thorax
/
Yeasts
/
Biopsy
/
Prednisolone
/
Crohn Disease
/
Fluconazole
/
Amphotericin B
/
Methotrexate
Limits:
Aged
/
Female
/
Humans
Country/Region as subject:
Asia
Language:
Korean
Journal:
The Journal of the Korean Rheumatism Association
Year:
2007
Type:
Article
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