A Case of Disseminated Histoplasmosis in a Patient with Rheumatoid Arthritis on Abatacept

被引：7
作者：
Jain, Nina [1 ]
Doyon, Jeffrey B. [1 ]
Lazarus, Jacob E. [1 ,2 ,3 ]
Schaefer, Inga-Marie [4 ]
Johncilla, Melanie E. [4 ]
Agoston, Agoston T. [4 ]
Dalal, Anuj K. [1 ]
Velasquez, Gustavo E. [1 ,2 ,5 ]
机构：
[1] Brigham & Womens Hosp, Dept Med, 75 Francis St, Boston, MA 02115 USA
[2] Brigham & Womens Hosp, Div Infect Dis, 75 Francis St, Boston, MA 02115 USA
[3] Massachusetts Gen Hosp, Div Infect Dis, Boston, MA 02114 USA
[4] Brigham & Womens Hosp, Dept Pathol, 75 Francis St, Boston, MA 02115 USA
[5] Harvard Med Sch, Dept Global Hlth & Social Med, Boston, MA 02115 USA
来源：
JOURNAL OF GENERAL INTERNAL MEDICINE | 2018年 / 33卷 / 05期
关键词：
infectious disease; arthritis; drugs; SERIOUS INFECTION; THERAPY; SAFETY; ADALIMUMAB; EFFICACY; RISK;
D O I：
10.1007/s11606-018-4383-0
中图分类号：
R19 [保健组织与事业（卫生事业管理）];
学科分类号：
摘要：
Biologic agents are effective treatments for rheumatoid arthritis but are associated with important risks, including severe infections. Tumor Necrosis Factor (TNF) alpha inhibitors are known to increase the risk of systemic fungal infections such as disseminated histoplasmosis. Abatacept is a biologic agent with a mechanism different from that of TNF alpha inhibitors: It suppresses cellular immunity by competing for the costimulatory signal on antigen-presenting cells. The risk of disseminated histoplasmosis for patients on abatacept is not known. We report a case of abatacept-associated disseminated histoplasmosis and review the known infectious complications of abatacept. While the safety of resuming biologic agents following treatment for disseminated histoplasmosis is also not known, abatacept is recommended over TNF alpha inhibitors for rheumatoid arthritis patients with a prior serious infection. We discuss the evidence supporting this recommendation and discuss alternative treatments for rheumatoid arthritis patients with a history of a serious infection.
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收藏
页码：769 / 772
页数：4
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