Buonomo Antonio Riccardo, Viceconte Giulio, Compare Debora, Vargas Maria, Iacovazzo Carmine, Zappulo Emanuela, Nardone Gerardo, Servillo Giuseppe, Borgia Guglielmo, Gentile Ivan
Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Italy.
Department of Clinical Medicine and Surgery, Section of Gastroenterology, University Federico II of Naples, Naples, Italy.
IDCases. 2019 Apr 16;17:e00537. doi: 10.1016/j.idcr.2019.e00537. eCollection 2019.
We report a case of concurrent development of active pulmonary tuberculosis and invasive pulmonary aspergillosis (IPA) in a patient who received therapy with infliximab for Crohn's disease. He has been treated with antitubercular therapy and liposomal amphotericin B for 8 weeks. His clinical course was complicated by paroxysmal atrial fibrillation requiring maintenance therapy with amiodarone, respiratory failure due both to pneumonia caused by methicillin-resistant (MRSA) and extended-spectrum beta-lactamases (ESBL)-producing and pleural effusion requiring chest drainage. At discharge, a maintenance regimen based on the administration of isavuconazole 200 mg daily, moxifloxacin 400 mg daily and isoniazid 300 mg daily was chosen to avoid multiple drug-drug interaction between rifamycins, antifungal triazole agents and antiarrhythmic drugs. At 3 months of follow-up his clinical conditions were dramatically improved, high resolution chest tomography (HRCT) showed reduction of parenchymal lesions and no changes both in sinus rhythm and QTc interval were noticed. Besides the complexity and the peculiarity of the clinical scenario, this case underlines the risk of invasive fungal infections linked to the administration of TNF-α antagonists in gastroenterological setting and the importance of accurate evaluation of drug-drug interactions when choosing the antimicrobial therapies.
我们报告了1例接受英夫利昔单抗治疗克罗恩病的患者同时发生活动性肺结核和侵袭性肺曲霉病（IPA）的病例。他接受抗结核治疗和脂质体两性霉素B治疗8周。其临床病程因阵发性心房颤动而复杂化，需要用胺碘酮进行维持治疗，因耐甲氧西林（MRSA）和产超广谱β-内酰胺酶（ESBL）的肺炎导致呼吸衰竭，以及因胸腔积液需要胸腔引流。出院时，选择了基于每日服用200mg艾沙康唑、每日服用400mg莫西沙星和每日服用300mg异烟肼的维持治疗方案，以避免利福霉素、抗真菌三唑类药物和抗心律失常药物之间的多种药物相互作用。在随访3个月时，他的临床状况显著改善，高分辨率胸部断层扫描（HRCT）显示实质病变减少，窦性心律和QTc间期均无变化。除了临床情况的复杂性和特殊性外，该病例强调了在胃肠病学环境中与使用TNF-α拮抗剂相关的侵袭性真菌感染风险，以及在选择抗菌治疗时准确评估药物相互作用的重要性。
