title: Coccidioidomycosis pneumonia in a nonendemic area associated with infliximab.
abstract: Tumor necrosis factor (TNF) inhibitors, such as infliximab, are highly effective in the management of rheumatoid arthritis; however, these agents are associated with an increased risk of infectious complications. Individuals developing coccidiomycosis pneumonia frequently acquire this while residing in endemic regions. We present a patient with rheumatoid arthritis treated with infliximab who developed acute respiratory distress syndrome (ARDS) from coccidiomycosis pneumonia while residing in a non-endemic region near the Texas-Louisiana border and was successfully treated with antifungal therapy. The source for coccidiomycosis was suspected to be from inhalation of pulverized rock dust imported from Arizona. Patients treated with TNF inhibitors may acquire coccidiomycosis infection through fomite dust exposure.
authors.affiliation: Division of Allergy, Pulmonary, Immunology, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA.
authors.forename: Mahmood
authors.initials: M
authors.lastname: Dweik
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Baethge
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Duarte
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D003047:Coccidioidomycosis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D000069285:Infliximab; D008172:Lung Diseases, Fungal / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D000069285:Infliximab