Fungal infections as a complication of therapy for sarcoidosis.
BACKGROUND
Treatment of symptomatic sarcoidosis usually includes systemic immunosuppressive agents. These agents may render the patient more susceptible to opportunistic infections. In addition, the fungal infection may be difficult to distinguish from the underlying sarcoidosis.


OBJECTIVE
To examine the presentation and management of invasive fungal infections in sarcoidosis patients.


METHODS
Retrospective record review.


METHODS
We reviewed the notes of all sarcoidosis patients (n = 753) seen at our clinic over an 18-month period.


RESULTS
Seven patients (0.9%) with previously diagnosed sarcoidosis developed fungal infections: two each with Histoplasma capsulatum and Blastomyces dermatitidis and three others with Cryptococcus neoformans. No cases of invasive aspergillus or tuberculosis were identified. The diagnosis of fungal infection was made by bronchoscopy (four cases), open-lung biopsy (one case), bone-marrow aspirate (one case), and spinal fluid examination (one case). All patients were receiving corticosteroids at the time of worsening chest X-ray or clinical status. Four patients were also receiving methotrexate prior to infection. No patient with systemic fungal infection was receiving either infliximab or cyclophosphamide. All patients responded to anti-fungal therapy and a reduction in immunosuppression.


CONCLUSIONS
Fungal infections occur rarely in treated patients with sarcoidosis. Deterioration of chest X-ray, especially a localized infiltrate, warrants investigation.
Baughman
R P
RP
Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA. bob.baughman@uc.edu
Lower
E E
EE
D000935:Antifungal Agents / Q000627:therapeutic use; D003453:Cryptococcosis / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects*; D009181:Mycoses / Q000139:chemically induced*; D009894:Opportunistic Infections / Q000188:drug therapy; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects*; D012189:Retrospective Studies; D017565:Sarcoidosis, Pulmonary / Q000188:drug therapy*
D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D011241:Prednisone; D008727:Methotrexate