title: Pulmonary cryptococcosis after initiation of anti-tumor necrosis factor-alpha therapy.
abstract: Many patients with rheumatoid arthritis are being treated with immunosuppressive regimens that include an agent directed at blocking tumor necrosis factor (TNF)-alpha. Although reportedly safe, tuberculous and fungal infections have emerged as significant complications of therapy. We report a case of pulmonary cryptococcosis soon after the initiation of therapy with the anti-TNF-alpha antibody, infliximab. A diagnosis was made early in the disease course, and the patient responded quickly to antifungal therapy. This case should alert clinicians to the increased incidence of pulmonary mycoses in patients receiving anti-TNF-alpha therapy.
authors.affiliation: Pulmonary Critical Care, Department of Medicine, Indiana University School of Medicine, 1001 West Tenth Street, Indianapolis, IN 46202, USA.
authors.forename: Chadi A
authors.initials: CA
authors.lastname: Hage
authors.forename: Karen L
authors.initials: KL
authors.lastname: Wood
authors.forename: Helen T
authors.initials: HT
authors.lastname: Winer-Muram
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Wilson
authors.forename: George
authors.initials: G
authors.lastname: Sarosi
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Knox
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D000935:Antifungal Agents / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D003453:Cryptococcosis / Q000139:chemically induced* / Q000188:drug therapy; D003455:Cryptococcus neoformans / Q000302:isolation & purification; D006801:Humans; D000069285:Infliximab; D008171:Lung Diseases / Q000139:chemically induced* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D000935:Antifungal Agents; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab