Disseminated coccidioidomycosis in a patient managed with adalimumab for Crohn's disease.
BACKGROUND
A 50-year-old man presented with a 2-3 month history of left lower quadrant abdominal pain, right periorbital headache, blurry vision, tinnitus, polydipsia, right elbow pain, and a 32 kg weight loss over the past year. He had a 34-year history of complicated Crohn's disease that was notable for surgical stricture repair and partial colectomy for bowel perforation. The patient was receiving mesalazine and 6-mercaptopurine and, 2 months before admission, had stopped a 4-month therapy course with the biologic agent adalimumab for treatment of Crohn's disease.


METHODS
Physical examination, brain and elbow MRI scans, chest CT scan, routine blood analyses, assessment of coccidioidomycosis antibody levels, immunodiffusion and complement fixation studies in serum and cerebrospinal fluid, full-body technetium-99m nuclear bone scan, hematoxylin and eosin staining of resected tissue specimens.


METHODS
Disseminated coccidioidomycosis with meningeal, bone, soft tissue and pulmonary involvement.


RESULTS
The patient underwent treatment with amphotericin B liposomal complex and oral fluconazole and right elbow surgical debridement and irrigation. All immunosuppressive therapy was stopped.
Mitter
Sumeet S
SS
David Geffen School of Medicine, UCLA, 10833 LeConte Avenue, 37-121 CHS, Los Angeles, CA 90095, USA.
Derhovanessian
Ariss
A
Hillman
Joseph D
JD
Uslan
Daniel Z
DZ
D000068879:Adalimumab; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D003047:Coccidioidomycosis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy*; D003937:Diagnosis, Differential; D004550:Elbow; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008875:Middle Aged
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000068879:Adalimumab