肿瘤坏死因子抑制剂治疗后并发播散性组织胞浆菌病和播散性结核病：一例报告
Concomitant disseminated histoplasmosis and disseminated tuberculosis after tumor necrosis factor inhibitor treatment: a case report.
作者信息
Muñoz-Oca Juan E, Villarreal Morales Martha L, Nieves-Rodriguez Aracelis, Martínez-Bonilla Lemuel
机构信息
JEMO: Family Medicine Residency Program, Manatí Medical Center, P.O Box 1142, Manatí, PR, 00674, USA.
MLVM: Department of Medical Education, Manatí Medical Center, P.O Box 1142, Manatí, PR, 00674, USA.
出版信息
BMC Infect Dis. 2017 Jan 13;17(1):70. doi: 10.1186/s12879-016-2097-7.
BACKGROUND
Tumor necrosis factor antagonist inhibitors have transformed the approach to patients with severe autoimmune conditions, such as rheumatoid arthritis. Although the therapy can be highly effective, TNF-α inhibitors are associated with an increased risk of opportunistic infections.
CASE PRESENTATION
Here, we report a case of concomitant disseminated histoplasmosis and tuberculosis in a 65-year-old female with rheumatoid arthritis treated with TNF-α inhibitor. Both conditions can be found in disseminated form in immunosuppressed hosts, but co-infection is rare with only a few cases having been reported, to our knowledge, all in HIV patients.
CONCLUSIONS
This case posed a considerable challenge for diagnosis and treatment due to the unusual disseminated co-infection, the overlapping symptoms, and the interactions between medications.
背景
肿瘤坏死因子拮抗剂已改变了对患有严重自身免疫性疾病（如类风湿关节炎）患者的治疗方法。尽管该疗法可能非常有效，但肿瘤坏死因子-α抑制剂与机会性感染风险增加相关。
病例报告
在此，我们报告一例65岁患有类风湿关节炎且接受肿瘤坏死因子-α抑制剂治疗的女性患者同时发生播散性组织胞浆菌病和结核病的病例。这两种疾病在免疫抑制宿主中均可呈播散形式出现，但合并感染罕见，据我们所知，仅有少数病例报道，且均为艾滋病患者。
结论
由于这种不寻常的播散性合并感染、重叠症状以及药物之间的相互作用，该病例在诊断和治疗方面构成了相当大的挑战。
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