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KMID : 0388220070140040412
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Journal of the Korean Rheumatism Association
2007 Volume.14 No. 4 p.412 ~ p.416
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A Case of Cryptococcal Pneumonia in a Rheumatoid Arthritis Patient after Tumor Necrosis Factor-alpha Antagonist Therapy
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Lee Seung-Min
Lee Jin-Soo
Kwon Seong-Ryul
Lim Mie-Jin
Park Won
Kim Lucia
Kwon Su-Hyun
Jeong Jae-Cheon
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Abstract
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Tumor necrosis factor-alpha (TNF-?) plays a important role in the pathogenesis of rheumatoid arthritis and Crohn’s disease, TNF-? antagonist has been widely used for these disease, but it also plays a major role in cell mediated immunity. Cryptococcus neoformans, an encapsulated, ubiquitous environmental yeast, is pathogenic for humans, primarily those with compromised immune function. Cryptococcus neoformans is believed to be a facultative intracellular pathogen. We report a case of pulmonary cryptococcosis after chimeric anti-TNF monoclonal antibody therapy. No case has been reported in Korea for the best of our knowledge. A 66-year old woman was admitted because of severe cough. She was diagnosed to have rheumatoid arthritis 4 years ago and taken prednisolone and methotrexate. She was started on infliximab and received ten doses, the last dose being administered 6 weeks prior to above symptom. Chest PA and computed tomography of chest revealed multifocal consolidative lesions in both lungs. Pulmonary cryptococcosis confirmed by thoracoscopic lung biopsy tissue stained with Grocott-Gomori methenamine-silver (GMS). Initially the lung lesion responded to amphotericin B but leukopenia developed after 12 days of treatment. It was changed to fluconazole, then leukopenia and the pneumonia also improved. Physicians should remind pulmonary cryptococcosis in patients receiving TNF-? antagonist therapy.
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KEYWORD
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Rheumatoid arthritis, Cryptococcal pneumonia, TNF-alpha blocker
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