Cavitating pneumonia after treatment with infliximab and prednisone.
Tumor necrosis factor (TNF)-alpha antagonists constitute a novel class of immunomodulating drugs that are used for the treatment of an increasing number of inflammatory disorders. These agents are associated with an increased risk of tuberculosis, but the risk of other infections is less clear. Reported here is the case of a patient who developed cavitary pneumonia after treatment with infliximab (monoclonal TNF-alpha antibodies) and corticosteroids for rheumatoid arthritis. Cryptococcus neoformans was the only pathogen isolated from bronchoalveolar lavage fluid. The patient responded well to fluconazole. The risk of infection after treatment with TNF-alpha antagonists and the possible causative microorganisms are discussed.
Arend
S M
SM
Department of Infectious Diseases C5P-39, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands. s.m.arend@lumc.nl
Kuijper
E J
EJ
Allaart
C F
CF
Muller
W Hissink
WH
Van Dissel
J T
JT
D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000276:immunology; D003453:Cryptococcosis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000188:drug therapy; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000069285:Infliximab; D008875:Middle Aged; D011014:Pneumonia / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D011241:Prednisone / Q000009:adverse effects* / Q000627:therapeutic use; D013902:Radiography, Thoracic; D018570:Risk Assessment; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D015725:Fluconazole; D000069285:Infliximab; D011241:Prednisone