Université Montpellier 1, Service de Médecine Interne A, Hôpital Saint-Eloi, 80 avenue Augustin Fliche, 34295 Montpellier Cedex 5, France.
J Crohns Colitis. 2013 Feb;7(1):e11-4. doi: 10.1016/j.crohns.2012.04.016. Epub 2012 May 29.
Biotherapies targeting TNFα were proven to be effective in the most severe cases of Crohn's Disease, a chronic granulomatous inflammatory bowel disease that can involve any portion of the digestive tract. The tolerance of anti-TNFα therapy is usually good, although several infectious complications have been reported with these drugs.
We report a case of a Crohn's disease patient who developed pulmonary cryptococcosis following chicken manure exposition while he received adalimumab and azathioprine.
A 54-year-old man, with history of severe Crohn's disease and ankylosing spondylitis, was admitted for diarrhea and abdominal pain under azathioprine treatment. In December 2010, he was treated with oral prednisone (1 mg/kg/day), but Crohn's disease relapsed when prednisone dose was lower than 30 mg/a day. The patient was then treated with adalimumab, but six weeks later he developed severe pulmonary cryptococcosis. The patient experienced a good outcome under antifungal therapy. We retrospectively found a high exposure to chicken manure in the last weeks.
Cryptococcosis is an opportunistic infection that can occur under anti-TNFα therapy. The environmental exposure to Cryptococcus spp. (in particular in chicken manure) is a source of contamination. Avoiding exposition to bird manure should be a recommendation for patients who are living in rural areas.
靶向 TNFα 的生物疗法已被证明对克罗恩病（一种可累及消化道任何部位的慢性肉芽肿性炎症性肠病）的最严重病例有效。尽管这些药物已报告有几种感染并发症，但抗 TNFα 治疗的耐受性通常良好。
我们报告了一例克罗恩病患者在接受阿达木单抗和硫唑嘌呤治疗时因接触鸡粪而发生肺部隐球菌病的病例。
一名 54 岁男性，有严重克罗恩病和强直性脊柱炎病史，因腹泻和腹痛在接受硫唑嘌呤治疗时入院。2010 年 12 月，他接受了口服泼尼松龙（1mg/kg/天）治疗，但当泼尼松龙剂量低于 30mg/天时，克罗恩病复发。随后患者接受了阿达木单抗治疗，但六周后他出现了严重的肺部隐球菌病。患者在抗真菌治疗后病情好转。我们回顾性发现，在最近几周，患者大量接触了鸡粪。
隐球菌病是一种机会性感染，可在抗 TNFα 治疗期间发生。接触隐球菌属（特别是鸡粪）是污染的来源。对于居住在农村地区的患者，应建议避免接触鸟粪。
