Abstract
References
- 1. Eisenman HC, Casadevall A, McClelland EE. New insights on the pathogenesis of invasive Cryptococcus neoformans infection. Curr Infect Dis Rep 2007;9:457-464. 2. Scott DG, Bacon PA, Tribe CR. Systemic rheumatoid vasculitis: a clinical and laboratory study of 50 cases. Medicine 1981; 60:288-297. 3. Liao TL, Chen YM, Chen DY. Risk factors for cryptococcal infection among patients with rheumatoid arthritis receiving different immunosuppressive medications. Clin Microbiol Infect 2016; 22: 815.e1-815.e3. 4. Gomes RM, Cerio DR, Loghmanee C, et al. Cutaneous cryptococcoma in a patient on TNF-α inhibition. J Clin Med 2013;2:260-263. 5. Horcajada JP, Pena JL, Martinez-Taboada VM, et al. Invasive cryptococcosis and adalimumab treatment. Emerg Infect Dis 2007; 13:953-955. 6. Wilson ML, Sewell LD, Mowad CM. Primary cutaneous cryptococcosis during therapy with methotrexate and adalimumab. J Drugs Derm 2008; 7:53-54. 7. Haag-Wackernagel D, Moch H. Health hazards posed by feral pigeons. J Infect 2004; 48:307-313. 8. Aruch DB, Bhusal Y, Hamill RJ. Unusual cause of cellulitis in a patient with hepatitis C and cirrhosis. Am J Med 2011;124: e7-e8. 9. Neuville S, et al. Primary cutaneous cryptococcosis: a distinct clinical entity. Clin Infect Dis 2003; 36:337-347. 10. Perfect J, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis 2010; 50:291-322. 11. Koo S, Marty FM, Baden LR. Infectious complications associated with immunomodulating biologic agents. Infect Dis Clin North Am. 2010;24:285-306. 12. Schiff MH, Burmester GR, Kent JD, et al. Safety analysis of adalimumab (Humira) in global clinical trials and US postmarketing surveillance of patients with rheumatoid arthritis. Ann Rheum Dis 2006; 65:889-894. 13. De Marie S. Diseases and drug-related interventions affecting host defence. Eur J Clin Microbiol Infect Dis 1993; 12:S36. 14. Lazera MS, Cavalcanti MA, Trilles L, et al. Cryptococcus neoformans var. gattii – evidence for a natural habitat related to decaying wood in a pottery tree hollow. Med Mycol 1998; 36:119-22. 15. Nenoff P, Handrick W, Krüger C, et al. Dermatomycoses due to pets and farm animals: neglected infections?. Hautarzt 2012; 63:848-858.
Cryptococcal Cellulitis in a Diabetic with Nephropathy on Adalimumab Therapy for Rheumatoid Arthritis
Abstract
Cutaneous
infection with Cryptococcus neoformans is rare but can occur in the setting of
rheumatoid arthritis due to immunosuppression. Risk factors include chronic
kidney disease and use of tumor necrosis factor-alpha (TNF-α) inhibitor
adalimumab. We report the fourth case of primary cutaneous cryptococcosis (PCC)
in a diabetic female more than 60 years old living in rural Northwest Tennessee
and taking adalimumab for rheumatoid arthritis. In a literature review of
existing cases, this is the second case involving simultaneous chronic kidney
disease and the first case in a diabetic and following extended TNF-α inhibitor
immunosuppression monotherapy. Physicians should consider cryptococcal
infection in a patient who develops cellulitis that is unresponsive to empiric
therapy. In addition, it is imperative to monitor rheumatoid arthritis patients
taking adalimumab closely and consider alternative agents in those with
pre-existing immunosuppression or known risk factors for opportunistic
infections as primary prevention.
Keywords
Cryptococcus neoformans rheumatoid arthritis adalimumab diabetes mellitus chronic kidney disease
References
- 1. Eisenman HC, Casadevall A, McClelland EE. New insights on the pathogenesis of invasive Cryptococcus neoformans infection. Curr Infect Dis Rep 2007;9:457-464. 2. Scott DG, Bacon PA, Tribe CR. Systemic rheumatoid vasculitis: a clinical and laboratory study of 50 cases. Medicine 1981; 60:288-297. 3. Liao TL, Chen YM, Chen DY. Risk factors for cryptococcal infection among patients with rheumatoid arthritis receiving different immunosuppressive medications. Clin Microbiol Infect 2016; 22: 815.e1-815.e3. 4. Gomes RM, Cerio DR, Loghmanee C, et al. Cutaneous cryptococcoma in a patient on TNF-α inhibition. J Clin Med 2013;2:260-263. 5. Horcajada JP, Pena JL, Martinez-Taboada VM, et al. Invasive cryptococcosis and adalimumab treatment. Emerg Infect Dis 2007; 13:953-955. 6. Wilson ML, Sewell LD, Mowad CM. Primary cutaneous cryptococcosis during therapy with methotrexate and adalimumab. J Drugs Derm 2008; 7:53-54. 7. Haag-Wackernagel D, Moch H. Health hazards posed by feral pigeons. J Infect 2004; 48:307-313. 8. Aruch DB, Bhusal Y, Hamill RJ. Unusual cause of cellulitis in a patient with hepatitis C and cirrhosis. Am J Med 2011;124: e7-e8. 9. Neuville S, et al. Primary cutaneous cryptococcosis: a distinct clinical entity. Clin Infect Dis 2003; 36:337-347. 10. Perfect J, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis 2010; 50:291-322. 11. Koo S, Marty FM, Baden LR. Infectious complications associated with immunomodulating biologic agents. Infect Dis Clin North Am. 2010;24:285-306. 12. Schiff MH, Burmester GR, Kent JD, et al. Safety analysis of adalimumab (Humira) in global clinical trials and US postmarketing surveillance of patients with rheumatoid arthritis. Ann Rheum Dis 2006; 65:889-894. 13. De Marie S. Diseases and drug-related interventions affecting host defence. Eur J Clin Microbiol Infect Dis 1993; 12:S36. 14. Lazera MS, Cavalcanti MA, Trilles L, et al. Cryptococcus neoformans var. gattii – evidence for a natural habitat related to decaying wood in a pottery tree hollow. Med Mycol 1998; 36:119-22. 15. Nenoff P, Handrick W, Krüger C, et al. Dermatomycoses due to pets and farm animals: neglected infections?. Hautarzt 2012; 63:848-858.
Details
| Journal Section | Case Report |
|---|---|
| Authors | |
| Publication Date | September 15, 2017 |
| Published in Issue | Year 2017 |