Infectious Diseases Section, VA Pittsburgh Healthcare System and University of Pittsburgh, PA 15240, USA.
Int J Infect Dis. 2010 May;14(5):e436-40. doi: 10.1016/j.ijid.2009.05.019. Epub 2009 Aug 6.
The ability of tumor necrosis factor (TNF)-alpha inhibitors to impair pivotal pro-inflammatory host defenses may facilitate the development of disseminated cryptococcosis. Gastrointestinal (GI) tract disease is an unusual presentation of this yeast infection. We describe a unique case of disseminated cryptococcosis presenting as colitis that mimicked an exacerbation of Crohn's disease in a TNF-alpha inhibitor recipient. Review of existing literature shows that in immunocompromised patients, GI cryptococcosis invariably coexists with disseminated cryptococcosis, often lacks prominent GI symptomatology, and is primarily diagnosed postmortem. In cases with opportunistic infections, discontinuation of TNF-alpha inhibitors is a common practice, however rapid rebound of inflammatory responses may incur the risk of immune reconstitution syndrome.
肿瘤坏死因子 (TNF)-α 抑制剂抑制关键促炎宿主防御的能力可能会促进播散性隐球菌病的发展。胃肠道 (GI) 疾病是这种酵母感染的不常见表现。我们描述了一例以结肠炎为表现的播散性隐球菌病的独特病例，该病例模仿了 TNF-α 抑制剂接受者中克罗恩病的恶化。对现有文献的回顾表明，在免疫功能低下的患者中，GI 隐球菌病总是与播散性隐球菌病并存，通常缺乏明显的 GI 症状，并且主要是在死后诊断的。在机会性感染的情况下，TNF-α 抑制剂的停药是常见的做法，但是炎症反应的快速反弹可能会导致免疫重建综合征的风险。
