Colitis as a manifestation of infliximab-associated disseminated cryptococcosis.
The ability of tumor necrosis factor (TNF)-alpha inhibitors to impair pivotal pro-inflammatory host defenses may facilitate the development of disseminated cryptococcosis. Gastrointestinal (GI) tract disease is an unusual presentation of this yeast infection. We describe a unique case of disseminated cryptococcosis presenting as colitis that mimicked an exacerbation of Crohn's disease in a TNF-alpha inhibitor recipient. Review of existing literature shows that in immunocompromised patients, GI cryptococcosis invariably coexists with disseminated cryptococcosis, often lacks prominent GI symptomatology, and is primarily diagnosed postmortem. In cases with opportunistic infections, discontinuation of TNF-alpha inhibitors is a common practice, however rapid rebound of inflammatory responses may incur the risk of immune reconstitution syndrome.
Osawa
Ryosuke
R
Infectious Diseases Section, VA Pittsburgh Healthcare System and University of Pittsburgh, PA 15240, USA.
Singh
Nina
N
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D000935:Antifungal Agents / Q000627:therapeutic use; D003092:Colitis / Q000139:chemically induced / Q000175:diagnosis* / Q000382:microbiology; D003424:Crohn Disease / Q000188:drug therapy; D003453:Cryptococcosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D003454:Cryptococcus / Q000254:growth & development*; D003937:Diagnosis, Differential; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000935:Antifungal Agents; D000069285:Infliximab