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Disseminated Histoplasmosis in an Adult With Rheumatoid Arthritis Not on Biological Immune Modulators

Histoplasmosis is a fungal disease caused by a dimorphic fungus known as Histoplasma capsulatum (H. capsulatum), which is endemic to areas around river valleys and southeastern states in the United States (US). Patients with histoplasmosis are asymptomatic, and the condition is usually diagnosed by...

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Autores principales: Avasthi, Deepti, Fatima, Huda, Gill, Mohinder, Avasthi, Salil
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8285937/
https://www.ncbi.nlm.nih.gov/pubmed/34277293
http://dx.doi.org/10.7759/cureus.15709
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author Avasthi, Deepti
Fatima, Huda
Gill, Mohinder
Avasthi, Salil
author_facet Avasthi, Deepti
Fatima, Huda
Gill, Mohinder
Avasthi, Salil
author_sort Avasthi, Deepti
collection PubMed
description Histoplasmosis is a fungal disease caused by a dimorphic fungus known as Histoplasma capsulatum (H. capsulatum), which is endemic to areas around river valleys and southeastern states in the United States (US). Patients with histoplasmosis are asymptomatic, and the condition is usually diagnosed by an incidental finding of a pulmonary granuloma on a chest radiograph. In rare cases, this disease can develop into a progressive disseminated form and cause fatal and diffuse pulmonary infiltrates in immunocompromised adults. Moreover, there is a close association between disseminated histoplasmosis and the use of tumor necrosis factor (TNF) inhibitors in rheumatoid arthritis (RA). Our case report discusses a unique presentation of disseminated histoplasmosis in a patient with RA who was not on any biological immune modulators. The disseminated histoplasmosis in this case was progressive and involved the central nervous system, liver, lungs, and oral mucosa and was treated successfully with amphotericin therapy. We also discuss the disease process in detail and hypothesize that RA could be an independent risk factor for the increased incidence of disseminated histoplasmosis in adults. Based on the findings in this case report, we recommend screening for latent Histoplasma infections in adults with RA living in endemic areas and keeping a low threshold to evaluate flare-ups from this disease regardless of the use of anti-TNF inhibitors. Specific experimental and epidemiological studies can be conducted to examine the association between RA and similar indolent fungal infections.
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spelling pubmed-82859372021-07-17 Disseminated Histoplasmosis in an Adult With Rheumatoid Arthritis Not on Biological Immune Modulators Avasthi, Deepti Fatima, Huda Gill, Mohinder Avasthi, Salil Cureus Infectious Disease Histoplasmosis is a fungal disease caused by a dimorphic fungus known as Histoplasma capsulatum (H. capsulatum), which is endemic to areas around river valleys and southeastern states in the United States (US). Patients with histoplasmosis are asymptomatic, and the condition is usually diagnosed by an incidental finding of a pulmonary granuloma on a chest radiograph. In rare cases, this disease can develop into a progressive disseminated form and cause fatal and diffuse pulmonary infiltrates in immunocompromised adults. Moreover, there is a close association between disseminated histoplasmosis and the use of tumor necrosis factor (TNF) inhibitors in rheumatoid arthritis (RA). Our case report discusses a unique presentation of disseminated histoplasmosis in a patient with RA who was not on any biological immune modulators. The disseminated histoplasmosis in this case was progressive and involved the central nervous system, liver, lungs, and oral mucosa and was treated successfully with amphotericin therapy. We also discuss the disease process in detail and hypothesize that RA could be an independent risk factor for the increased incidence of disseminated histoplasmosis in adults. Based on the findings in this case report, we recommend screening for latent Histoplasma infections in adults with RA living in endemic areas and keeping a low threshold to evaluate flare-ups from this disease regardless of the use of anti-TNF inhibitors. Specific experimental and epidemiological studies can be conducted to examine the association between RA and similar indolent fungal infections. Cureus 2021-06-17 /pmc/articles/PMC8285937/ /pubmed/34277293 http://dx.doi.org/10.7759/cureus.15709 Text en Copyright © 2021, Avasthi et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Infectious Disease
Avasthi, Deepti
Fatima, Huda
Gill, Mohinder
Avasthi, Salil
Disseminated Histoplasmosis in an Adult With Rheumatoid Arthritis Not on Biological Immune Modulators
title Disseminated Histoplasmosis in an Adult With Rheumatoid Arthritis Not on Biological Immune Modulators
title_full Disseminated Histoplasmosis in an Adult With Rheumatoid Arthritis Not on Biological Immune Modulators
title_fullStr Disseminated Histoplasmosis in an Adult With Rheumatoid Arthritis Not on Biological Immune Modulators
title_full_unstemmed Disseminated Histoplasmosis in an Adult With Rheumatoid Arthritis Not on Biological Immune Modulators
title_short Disseminated Histoplasmosis in an Adult With Rheumatoid Arthritis Not on Biological Immune Modulators
title_sort disseminated histoplasmosis in an adult with rheumatoid arthritis not on biological immune modulators
topic Infectious Disease
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8285937/
https://www.ncbi.nlm.nih.gov/pubmed/34277293
http://dx.doi.org/10.7759/cureus.15709
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