Pinheiro Bruno do Valle, Delgado Aureo de Almeida, Chebli Julio Maria Fonseca
Divisão de Pneumologia, Departamento de Medicina, Hospital da Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil.
Departamento de Medicina, Hospital Santa Casa, Juiz de Fora, MG, Brasil.
Arq Gastroenterol. 2014 Jan-Mar;51(1):73-6. doi: 10.1590/s0004-28032014000100015.
Tumor necrosis factor-alpha (TNF-α) inhibitor therapy plays a pivotal role in the management of moderate to severe inflammatory bowel disease. Because of the role of TNF-α in the host defenses, anti-TNF therapy has been associated with an increase the risks of granulomatous infections.
To report the first case of adalimumab-associated invasive histoplasmosis presenting as an acute hepatitis-like syndrome and febrile pneumonitis in a patient with Crohn's disease.
Case report of a patient with progressive histoplasmosis confirmed by percutaneous fine needle aspiration biopsy lung and urine Histoplasma antigen.
We present the case of a young man with CD who developed pneumonia and acute hepatitis-like features caused by Histoplasma capsulatum infection during adalimumab therapy. To the best of our knowledge, this acute hepatitis-like manifestation has never been reported as a presentation of the histoplasmosis in patients with Crohn's disease.
This case underscores the potential risk for serious infection that may arise in this setting and should alert clinicians to the need to consider the histoplasmosis diagnosis in patients presenting with acute hepatitis-like syndrome associated with prolonged febrile illness or pneumonitis during therapy with anti-TNF-α antibodies.
肿瘤坏死因子-α（TNF-α）抑制剂疗法在中重度炎症性肠病的治疗中起着关键作用。由于TNF-α在宿主防御中的作用，抗TNF治疗与肉芽肿性感染风险增加有关。
报告首例在克罗恩病患者中出现的与阿达木单抗相关的侵袭性组织胞浆菌病，表现为急性肝炎样综合征和发热性肺炎。
通过经皮细针穿刺肺活检及尿组织胞浆菌抗原确诊为进行性组织胞浆菌病患者的病例报告。
我们报告了一例年轻的克罗恩病患者，在接受阿达木单抗治疗期间发生了由荚膜组织胞浆菌感染引起的肺炎和急性肝炎样症状。据我们所知，这种急性肝炎样表现从未被报道为克罗恩病患者组织胞浆菌病的表现。
该病例强调了在这种情况下可能出现严重感染的潜在风险，并应提醒临床医生，对于在抗TNF-α抗体治疗期间出现与长期发热性疾病或肺炎相关的急性肝炎样综合征的患者，需要考虑组织胞浆菌病的诊断。
