Witty L A, Steiner F, Curfman M, Webb D, Wheat L J
Department of Epidemiology, Ball Memorial Hospital, Muncie, Ind.
Arch Dermatol. 1992 Jan;128(1):91-3.
Low-dose methotrexate sodium therapy used for nonmalignant disease has been associated with a variety of opportunistic infections with pathogens occurring in patients with defective cellular immunity. This article describes the unusual development of disseminated histoplasmosis as a probable complication of immunosuppression resulting from use of methotrexate.
We report the cases of three patients in whom disseminated histoplasmosis developed while receiving low-dose methotrexate therapy for psoriasis. Disease manifestations were unusually severe in two of the three patients. All three cases were disseminated, and two cases resulted in illnesses requiring intensive medical treatment. Each patient responded appropriately to antifungal treatment, although one patient has required long-term suppressive treatment because of persistent Histoplasma antigenuria. These cases illustrate the risk for opportunistic fungal infections in patients receiving low-dose methotrexate therapy for nonmalignant diseases.
Histoplasma should be added to the list of pathogens to be suspected in patients receiving such therapy.
用于非恶性疾病的低剂量甲氨蝶呤钠治疗与细胞免疫缺陷患者发生的多种机会性感染病原体有关。本文描述了播散性组织胞浆菌病作为使用甲氨蝶呤导致免疫抑制的可能并发症的不寻常发展情况。
我们报告了3例患者的病例，这些患者在接受低剂量甲氨蝶呤治疗银屑病时发生了播散性组织胞浆菌病。在这3例患者中有2例的疾病表现异常严重。所有3例均为播散性，其中2例导致需要强化治疗的疾病。尽管有1例患者因持续的组织胞浆菌抗原尿需要长期抑制治疗，但每位患者对抗真菌治疗均有适当反应。这些病例说明了接受低剂量甲氨蝶呤治疗非恶性疾病的患者发生机会性真菌感染的风险。
组织胞浆菌应添加到接受此类治疗患者的可疑病原体名单中。
