Hepatitis and pneumonitis during adalimumab therapy in Crohn disease: mind the histoplasmosis!
BACKGROUND
Tumor necrosis factor-alpha (TNF-α) inhibitor therapy plays a pivotal role in the management of moderate to severe inflammatory bowel disease. Because of the role of TNF-α in the host defenses, anti-TNF therapy has been associated with an increase the risks of granulomatous infections.


OBJECTIVE
To report the first case of adalimumab-associated invasive histoplasmosis presenting as an acute hepatitis-like syndrome and febrile pneumonitis in a patient with Crohn's disease.


METHODS
Case report of a patient with progressive histoplasmosis confirmed by percutaneous fine needle aspiration biopsy lung and urine Histoplasma antigen.


RESULTS
We present the case of a young man with CD who developed pneumonia and acute hepatitis-like features caused by Histoplasma capsulatum infection during adalimumab therapy. To the best of our knowledge, this acute hepatitis-like manifestation has never been reported as a presentation of the histoplasmosis in patients with Crohn's disease.


CONCLUSIONS
This case underscores the potential risk for serious infection that may arise in this setting and should alert clinicians to the need to consider the histoplasmosis diagnosis in patients presenting with acute hepatitis-like syndrome associated with prolonged febrile illness or pneumonitis during therapy with anti-TNF-α antibodies.
Divisão de Pneumologia, Departamento de Medicina, Hospital da Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil.
Bruno do Valle
Bdo V
Pinheiro
Departamento de Medicina, Hospital Santa Casa, Juiz de Fora, MG, Brasil.
Aureo de Almeida
Ade A
Delgado
Divisão de Gastroenterologia, Departamento de Medicina, Centro de Doenças Inflamatórias Intestinais, Hospital da Universidade Federal de Juiz de Fora>, Juiz de Fora, MG, Brasil.
Julio Maria Fonseca
JM
Chebli
D000208:Acute Disease; D000068879:Adalimumab; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D003424:Crohn Disease / Q000188:drug therapy; D006505:Hepatitis / Q000209:etiology*; D006660:Histoplasmosis / Q000139:chemically induced*; D006801:Humans; D008297:Male; D011014:Pneumonia / Q000139:chemically induced*
D000893:Anti-Inflammatory Agents; D061067:Antibodies, Monoclonal, Humanized; D000068879:Adalimumab