干旱区生态环境知识资源中心(Arid): Disseminated coccidioidomycosis in a patient with juvenile idiopathic arthritis receiving infliximab

Arid

DOI	10.1186/s12969-021-00549-7
	Disseminated coccidioidomycosis in a patient with juvenile idiopathic arthritis receiving infliximab
	Trainor, Megan; Henkel, Emily; Diaz, Lucia Z.; Carrasco, Ruy
通讯作者	Trainor, M (corresponding author), Univ Texas Austin, Dell Med Sch, Div Dermatol, 601 E 15th St,CEC C2-470, Austin, TX 78701 USA.
来源期刊	PEDIATRIC RHEUMATOLOGY
EISSN	1546-0096
出版年	2021
卷号	19 期号:1
英文摘要	Background: Coccidioides immitis is a dimorphic fungus endemic to the arid climates of the Southwest United States, Mexico and parts of Central and South America. Human infection occurs through inhalation of spores with less than half of exposures progressing to a symptomatic state that primarily consists of pulmonary manifestations. Disseminated coccidioidomycosis is exceedingly rare, occurring in fewer than 1 % of symptomatic infections. Through hematogenous spread, the fungus can infect most organ systems and may be fatal without systemic antifungal treatment. Individuals with impaired cell-mediated immunity either from primary immunodeficiency disorders or secondary to immunosuppression with medications such as tumor necrosis factor alpha (TNF-alpha) inhibitors have increased risk of disseminated coccidioidomycosis and previous cases of coccidioidomycosis have been reported with biologic therapy. Case presentation: We present a case of disseminated coccidioidomycosis in a 16-year-old female with polyarticular juvenile idiopathic arthritis (JIA) being treated with prednisone, methotrexate, and infliximab. The patient presented with symptoms of meningeal irritation, bilateral choroidal lesions, and necrotizing peripheral pneumonia. Her infection was thought to be a reactivation of coccidioidomycosis given her history of resolved pneumonia that occurred after traveling to Arizona, New Mexico, and El Paso one year prior to presentation. Following diagnosis, she improved with discontinuation of her immunosuppressive medications and two weeks of intravenous amphotericin B and fluconazole with plans for lifetime treatment with fluconazole while immunosuppressed. Due to worsening arthritis, she will begin tofacitinib and continue close monitoring of chest x-rays and coccidioides antibody. Conclusions: Patients undergoing immunosuppressive therapy for rheumatological conditions are at increased risk of disseminated coccidioidomycosis and should be evaluated with high suspicion when presenting with atypical symptoms and history of travel to endemic regions.
英文关键词	Coccidioides immitis Corticosteroids Disseminated coccidioidomycosis Coccidioidomycosis Juvenile idiopathic arthritis Infliximab Methotrexate Tumor necrosis factor alpha (TNF-alpha) inhibitors
类型	Article
语种	英语
开放获取类型	gold, Green Published
收录类别	SCI-E
WOS记录号	WOS:000656326300004
WOS关键词	RISK
WOS类目	Pediatrics ; Rheumatology
WOS研究方向	Pediatrics ; Rheumatology
资源类型	期刊论文
条目标识符	http://119.78.100.177/qdio/handle/2XILL650/368804
作者单位	[Trainor, Megan; Diaz, Lucia Z.] Univ Texas Austin, Dell Med Sch, Div Dermatol, 601 E 15th St,CEC C2-470, Austin, TX 78701 USA; [Henkel, Emily] Univ Texas Hlth Sci Ctr San Antonio, Long Sch Med, San Antonio, TX 78229 USA; [Diaz, Lucia Z.] Dell Childrens Med Ctr, Austin, TX USA; [Diaz, Lucia Z.] Univ Texas Austin, Dell Med Sch, Dept Pediat, Austin, TX 78712 USA; [Carrasco, Ruy] Presbyterian Healthcare Serv, Albuquerque, NM USA
推荐引用方式 GB/T 7714	Trainor, Megan,Henkel, Emily,Diaz, Lucia Z.,et al. Disseminated coccidioidomycosis in a patient with juvenile idiopathic arthritis receiving infliximab[J],2021,19(1).
APA	Trainor, Megan,Henkel, Emily,Diaz, Lucia Z.,&Carrasco, Ruy.(2021).Disseminated coccidioidomycosis in a patient with juvenile idiopathic arthritis receiving infliximab.PEDIATRIC RHEUMATOLOGY,19(1).
MLA	Trainor, Megan,et al."Disseminated coccidioidomycosis in a patient with juvenile idiopathic arthritis receiving infliximab".PEDIATRIC RHEUMATOLOGY 19.1(2021).