Immune reconstitution inflammatory syndrome associated with disseminated histoplasmosis and TNF-alpha inhibition

Wright, Theodore; Çoruh, Başak; Fredricks, David N.; Kim, Nina

doi:10.1016/j.mmcr.2018.12.008

Cited by 9 publications

(4 citation statements)

References 16 publications

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“…Although IRIS is more classically described with the introduction of antiretroviral therapy in patients with HIV and concomitant opportunistic infections,11 there have been cases described in the literature of IRIS associated with disseminated histoplasmosis when TNF-alpha inhibitors have been stopped and liposomal amphotericin B started 12. In this case report, a patient taking infliximab for Crohn’s disease developed fever, hypotension, tachycardia and hypoxaemia 6 hours after receiving liposomal amphotericin B for disseminated histoplasmosis.…”

Section: Discussionmentioning

confidence: 85%

Disseminated histoplasmosis in an immunosuppressed patient successfully treated with isavuconazole

Sircar,

Tran,

Vaidya

et al. 2023

BMJ Case Rep

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Histoplasmosis is an endemic fungal infection caused by the dimorphic fungus,Histoplasma capsulatum,which is treated with intravenous amphotericin B and oral itraconazole as first-line and second-line therapy. We report a case of a man in his early 70s treated with methotrexate and infliximab for rheumatoid arthritis who developed disseminated histoplasmosis. The patient was unable to absorb itraconazole due to intractable diarrhoea and developed a severe, anaphylactoid reaction or an immune reconstitution inflammatory syndrome when treated with liposomal amphotericin B. He was subsequently treated with isavuconazole and steroids and made a full recovery.A literature review revealed other cases of histoplasmosis which were treated with isavuconazole including both primary pulmonary and disseminated presentations. Cases of blastomycosis which were treated with isavuconazole are also reviewed including those with severe immunocompromised statuses including solid-organ transplant and tumour necrosis factor-alpha antagonist recipients. Our report describes the potential role of isavuconazole in cases of histoplasmosis where first-line and second-line therapies have failed or are contraindicated (excluding meningitis).

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Section: Discussionmentioning

confidence: 85%

Disseminated histoplasmosis in an immunosuppressed patient successfully treated with isavuconazole

Sircar,

Tran,

Vaidya

et al. 2023

BMJ Case Rep

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“…Less frequently, pleural or pericardial effusions can also occur during immune reconstitution syndrome, due to an excessive inflammatory response against the pathogen after a rapidly restored immune system. This finding has been especially reported in histoplasmosis infection in immunocompromised patients (HIV, immunomodulatory therapy) [23,24]. Additionally, empyema may complicate some cases of pleural effusions [4].…”

Section: Non-resolving Pneumoniamentioning

confidence: 84%

Chest Imaging in Systemic Endemic Mycoses

Sousa

Marchiori

Youssef

et al. 2022

JoF

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Endemic fungal infections are responsible for high rates of morbidity and mortality in certain regions of the world. The diagnosis and management remain a challenge, and the reason could be explained by the lack of disease awareness, variability of symptoms, and insidious and often overlooked clinical presentation. Imaging findings are nonspecific and frequently misinterpreted as other more common infectious or malignant diseases. Patient demographics and clinical and travel history are important clues that may lead to a proper diagnosis. The purpose of this paper is to review the presentation and differential diagnosis of endemic mycoses based on the most common chest imaging findings.

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“…The present case’s histological features support a Type IVa reaction pattern, driven by histiocyte secretion of IFN-gamma and the induction of granulomatous inflammation [ 12 ]. One hypothesis may involve the patient’s discontinuation of infliximab, a TNF-alpha inhibitor, and a drug reaction similar to immune reconstitution inflammatory syndrome [ 13 ]. Removing the suppression of TNF-alpha, followed by a drug reaction, could cause excessive stimulation of histiocytes through a rebounded TNF-alpha inflammatory response, resulting in the secretion of IL-12.…”

Section: Discussionmentioning

confidence: 99%

Abatacept-Induced Panniculitis With Necrobiosis Lipoidica-Like Features in a Patient With Rheumatoid Arthritis

Mahlberg¹,

Pham²,

DeClerck³

et al. 2021

Cureus

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We present a 57-year-old female with a past medical history of rheumatoid arthritis, hypertension, and hypothyroidism who presented with poorly demarcated, nonblanching, painful, erythematous nodules on the bilateral lower legs for two weeks. The patient recently switched from infliximab to abatacept infusions, and skin eruptions presented 53 days from her initial abatacept infusion. A 5 mm punch biopsy of the left anterior upper leg in the zone of involvement showed a deep dermal granulomatous infiltrate with associated eosinophils and a vaguely horizontally palisaded pattern with necrobiosis. The granulomatous inflammation extended into the subcutaneous septae with a widening of the septae, edema, and lipomembranous fat necrosis. The patient was started on naproxen 500 mg PO BID and halobetasol propionate 0.05% lotion BID. Concomitantly, she was started on a four-day course of oral prednisone 10 mg PO daily and restarted infliximab infusions on the third day of prednisone treatment. At her initial infliximab infusions, she received one dose of solumedrol 40 mg and diphenhydramine 50 mg. The eruption resolved 21 days after the initial presentation. The present case is unique from the nine other cutaneous eruptions described after initiating abatacept therapy. Less than 10 cases of cutaneous panniculitides have been reported as adverse reactions to abatacept, with the most common reactions associated with oral contraceptives, nonsteroidal anti-inflammatory drugs, antibiotics, and leukotriene modifying agents. This case underscores the variety of histological findings in drug-induced panniculitis, highlighting the possibility of a drug reaction in a patient with rheumatological disease presenting with panniculitis.

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Immune reconstitution inflammatory syndrome associated with disseminated histoplasmosis and TNF-alpha inhibition

Cited by 9 publications

References 16 publications

Disseminated histoplasmosis in an immunosuppressed patient successfully treated with isavuconazole

Disseminated histoplasmosis in an immunosuppressed patient successfully treated with isavuconazole

Chest Imaging in Systemic Endemic Mycoses

Abatacept-Induced Panniculitis With Necrobiosis Lipoidica-Like Features in a Patient With Rheumatoid Arthritis

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