Disseminated cryptococcosis by biological therapy: We must manage the risk
Abstract
Introduction: Multiple adverse effects have been described for the biological therapy in autoimmune diseases including many secondary to immunosuppression producing
bacterial, fungal, or viral infections.
Clinical case: We present the case of a 64-year-old female patient with proven disseminated cryptococcosis secondary to the use of tofacitinib. Other possible causes
of immunosuppression such as the human immunodeficiency virus (HIV) were ruled out. The patient had been in treatment for rheumatoid arthritis diagnosed three years before. This drug is a biological agent that inhibits JAK enzymes. Very few cases of pulmonary and meningeal cryptococcosis in this type of patient have been described in the literature.
Conclusion: This case report should be useful for other clinicians to bear in mind the possibility of this type of invasive fungal infection associated with biological therapy and to take a risk-management approach.
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References
Dhillon S. Tofacitinib: A review in rheumatoid arthritis. Drugs. 2017;77:1987-2001. https://doi.org/10.1007/s40265-017-0835-9
Maziarz EK. Cryptococcosis. Infect Dis Clin North Am. 2016;30:179-206. https://doi.org/10.1016/j.idc.2015.10.004
Molloy SF, Chiller T, Greene GS, Burry J, Govender NP, Kanyama C, et al. Cryptococcal meningitis: A neglected NTD? PLoS Negl Trop Dis. 2017;11:e0005575. https://doi.org/10.1371/JOURNAL.PNTD.0005575
Cada D, Demaris K, Levien T, Baker D. Tofacitinib. Hospital Pharmacy. 2013;48:413-24. https://doi.org/10.1310/hpj4805-413
Sandborn WJ. Tofacitinib as induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2017;376:1723-36. https://doi.org/10.1056/nejmoa1606910
Zhang Z, Deng W, Wu Q, Sun L. Tuberculosis, hepatitis B and herpes zoster in tofacitinibtreated patients with rheumatoid arthritis. Immunotherapy. 2019;11:321-33.
Winthrop KL, Park SH, Gul A, Cardiel MH, Gómez-Reino JJ, Tanaka Y, et al. Tuberculosis and other opportunistic infections in tofacitinib-treated patients with rheumatoid arthritis. Ann Rheum Dis. 2016;75:1133-8. https://doi.org/10.1136/annrheumdis-2015-207319
Seminario-Vidal L, Cantrell W, Elewski BE. Pulmonary cryptococcosis in the setting of tofacitinib therapy for psoriasis. J Drugs Dermatol. 2015;14:901-2.
Kremer J, Li ZG, Hall S, Fleischmann R, Genovese M, Martin-Mola E, et al. Tofacitinib in combination with nonbiologic disease-modifying antirheumatic drugs in patients with active rheumatoid arthritis. Ann Intern Med. 2013;159:253-26. https://doi.org/10.7326/0003-4819-159-4-201308200-00006
Berekmeri A, Mahmood F, Wittmann M, Helliwell P. Tofacitinib for the treatment of psoriasis and psoriatic arthritis. Expert Rev Clin Immunol. 2018;14:719-30. https://doi.org/10.1080/1744666X.2018.1512404
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