Sinus aspergilloma in rheumatoid arthritis before or during tumor necrosis factor-alpha antagonist therapy.
BACKGROUND
In 2008, the Food and Drugs Administration required manufacturers of TNFalpha antagonists to strengthen their warnings about the risk of serious fungal infections in patients with rheumatoid arthritis (RA). Sinus aspergilloma occurs occasionally in RA patients and can progress to invasive Aspergillus disease. The purpose of this study was to describe symptomatic sinus aspergilloma in RA patients treated with TNFalpha antagonists.


METHODS
Retrospective descriptive study of symptomatic cases of sinus aspergilloma in patients with RA followed in three French university hospitals. A systematic literature review was performed.


RESULTS
Among 550 RA patients treated with TNFalpha antagonists, six (1.1%) had symptomatic maxillary aspergilloma diagnosed by computed tomography before or during TNFalpha antagonist therapy. None had chronic neutropenia. Aspergilloma treatment was with surgery only in all six patients. In the literature, we found 20 reports of Aspergillus infection in patients with chronic inflammatory joint diseases (including 10 with RA). Only 5/20 patients were treated with TNFalpha antagonists (invasive lung aspergillosis, n = 3; intracranial aspergillosis, n = 1; and sphenoidal sinusitis, n = 1).


CONCLUSIONS
Otorhinolaryngological symptoms must be evaluated before starting or switching TNFalpha antagonists. Routine computed tomography of the sinuses before starting or switching TNFalpha antagonists may deserve consideration.
Leboime
Ariane
A
Fédération de Rhumatologie, Pôle Appareil Locomoteur (centre Viggo Petersen), Hôpital Lariboisière, Paris Diderot University, 2 rue Ambroise Paré, Paris 75010, France. ariane_leboime@hotmail.com
Berthelot
Jean-Marie
JM
Allanore
Yannick
Y
Khalil-Kallouche
Lama
L
Herman
Philippe
P
Orcel
Philippe
P
Lioté
Frédéric
F
D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy; D001228:Aspergillosis / Q000150:complications* / Q000601:surgery; D000068800:Etanercept; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D000069285:Infliximab; D008875:Middle Aged; D010254:Paranasal Sinus Diseases / Q000150:complications* / Q000601:surgery; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012189:Retrospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068800:Etanercept