Infliximab-induced disseminated histoplasmosis in a patient with Crohn's disease.
BACKGROUND
A 56-year-old female with a 30-year history of ileocolic Crohn's disease presented with a 1-month history of bloody diarrhea and decreased caliber of stools; physical examination revealed a broad indurated anal fissure. The patient had been receiving antimetabolite therapy with 6-mercaptopurine and maintenance therapy with infliximab for over a year.


METHODS
Physical examination; proctoscopy; perianal and anal canal biopsy; chest CT; blood and stool analysis, measurement of serum histoplasmosis antibodies and urine histoplasmosis antigen levels; fungal culture and Gomori's methenamine silver staining of resected tissue specimens.


METHODS
Disseminated histoplasmosis.


RESULTS
Proctocolectomy and end ileostomy followed by treatment with liposomal amphotericin and then oral itraconazole. A palmar space abscess required multiple debridements, and a muscle flap to cover the defect.
Galandiuk
Susan
S
University of Louisville, Louisville, KY 40292, USA. s0gala01@louisville.edu
Davis
Brian R
BR
D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D003424:Crohn Disease / Q000188:drug therapy*; D005260:Female; D006660:Histoplasmosis / Q000139:chemically induced*; D006801:Humans; D000069285:Infliximab; D008875:Middle Aged
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000069285:Infliximab