title: Histoplasmosis infection in patients with rheumatoid arthritis, 1998-2009.
abstract: BACKGROUND
  Patients with rheumatic diseases including rheumatoid arthritis (RA) are at increased risk for infections related to both the disease and its treatments. These include uncommonly reported infections due to histoplasmosis.
  
  
  METHODS
  Medical record review of all patients with a diagnosis of RA who developed new histoplasmosis infection in an endemic region between Jan 1, 1998 and Jan 30, 2009 and who were seen at Mayo Clinic in Rochester, Minnesota was performed.
  
  
  RESULTS
  Histoplasmosis was diagnosed in 26 patients. Most patients were on combination therapies; 15 were on anti-tumor necrosis factor (anti-TNF) agents, 15 on corticosteroids and 16 on methotrexate. Most received more than 6 months of itraconazole and/or amphotericin treatment. Two patients died of causes unrelated to histoplasmosis. Anti-TNF treatment was restarted in 4/15 patients, with recurrence of histoplasmosis in one.
  
  
  CONCLUSIONS
  In this largest single center series of patients with RA and histoplasmosis in the era of immunomodulatory therapy, we found that most patients had longstanding disease and were on multiple immunomodulatory agents. Most cases were pulmonary; typical signs and symptoms of disease were frequently lacking.
authors: Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
authors: Timothy C
authors: TC
authors: Olson
authors: Tim
authors: T
authors: Bongartz
authors: Cynthia S
authors: CS
authors: Crowson
authors: Glenn D
authors: GD
authors: Roberts
authors: Robert
authors: R
authors: Orenstein
authors: Eric L
authors: EL
authors: Matteson
references: Clin Infect Dis. 2005 Aug 1;41 Suppl 3:S204-7
references: 15983901
references: N Engl J Med. 1986 Jan 9;314(2):83-8
references: 3941695
references: J Acquir Immune Defic Syndr Hum Retrovirol. 1997 Oct 1;16(2):100-7
references: 9358104
references: Arthritis Rheum. 2002 Oct;46(10):2565-70
references: 12384912
references: Mayo Clin Proc. 2008 Feb;83(2):181-94
references: 18241628
references: Clin Microbiol Rev. 2007 Jan;20(1):115-32
references: 17223625
references: Clin Infect Dis. 2010 Jan 1;50(1):85-92
references: 19951231
references: Transpl Infect Dis. 2002 Sep;4(3):148-51
references: 12421460
references: Medicine (Baltimore). 2007 May;86(3):162-169
references: 17505255
references: Clin Infect Dis. 2000 Apr;30(4):688-95
references: 10770731
references: JAMA. 2006 May 17;295(19):2275-85
references: 16705109
references: Clin Infect Dis. 2004 May 1;38(9):1261-5
references: 15127338
references: Respir Med. 2006 Jul;100(7):1291-3
references: 16545951
references: Am J Respir Crit Care Med. 2003 May 1;167(9):1279-82
references: 12615627
references: Pharmacotherapy. 2005 Sep;25(9):1181-92
references: 16164393
references: Medicine (Baltimore). 1983 Sep;62(5):263-70
references: 6312246
references: Clin Infect Dis. 2007 Oct 1;45(7):807-25
references: 17806045
references: Arthritis Rheum. 1988 Mar;31(3):315-24
references: 3358796