Relapsed Pulmonary Cryptococcosis during Tumor Necrosis Factor α Inhibitor Treatment

Takahiro Takazono; Toyomitsu Sawai; Masato Tashiro; Tomomi Saijo; Kazuko Yamamoto; Yoshifumi Imamura; Taiga Miyazaki; Naofumi Suyama; Koichi Izumikawa; Hiroshi Kakeya; Katsunori Yanagihara; Hiroshi Mukae; Shigeru Kohno

doi:10.2169/internalmedicine.55.6969

CASE REPORTS

Relapsed Pulmonary Cryptococcosis during Tumor Necrosis Factor α Inhibitor Treatment

Takahiro Takazono, Toyomitsu Sawai, Masato Tashiro, Tomomi Saijo, Kazuko Yamamoto, Yoshifumi Imamura, Taiga Miyazaki, Naofumi Suyama, Koichi Izumikawa, Hiroshi Kakeya, Katsunori Yanagihara, Hiroshi Mukae, Shigeru Kohno

Author information

Takahiro Takazono
Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Japan
Second Department of Internal Medicine, Nagasaki University Hospital, Japan
Toyomitsu Sawai
Department of Internal Medicine, Nagasaki Municipal Hospital, Japan
Masato Tashiro
Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Japan
Tomomi Saijo
Second Department of Internal Medicine, Nagasaki University Hospital, Japan
Kazuko Yamamoto
Second Department of Internal Medicine, Nagasaki University Hospital, Japan
Yoshifumi Imamura
Second Department of Internal Medicine, Nagasaki University Hospital, Japan
Taiga Miyazaki
Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Japan
Second Department of Internal Medicine, Nagasaki University Hospital, Japan
Naofumi Suyama
Department of Internal Medicine, Nagasaki Municipal Hospital, Japan
Koichi Izumikawa
Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Japan
Hiroshi Kakeya
Department of Infection Control Science, Graduate School of Medicine, Osaka City University, Japan
Katsunori Yanagihara
Department of Laboratory Medicine, Nagasaki University Hospital, Japan
Hiroshi Mukae
Second Department of Internal Medicine, Nagasaki University Hospital, Japan
Shigeru Kohno
Second Department of Internal Medicine, Nagasaki University Hospital, Japan

Keywords: pulmonary cryptococcosis, relapse, infliximab, tumor necrosis factor α inhibitor, biological agents

JOURNAL OPEN ACCESS

2016 Volume 55 Issue 19 Pages 2877-2880

DOI https://doi.org/10.2169/internalmedicine.55.6969

Details

Abstract

A 35-year-old non-HIV patient developed pulmonary cryptococcosis after the initiation of infliximab. He recovered by fluconazole treatment and completed the therapy for a total of 6 months. However, he experienced a relapse 16 months later during retreatment with infliximab, revealing an interesting clinical course contradicting retreatment. This case also represents the first case of relapsed pulmonary cryptococcosis suspected during treatment with a biologic agent. Both of these aspects generated important clinical questions about the length of pulmonary cryptococcosis treatment and the necessity of introducing a second prophylaxis for such patients.

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