Cryptococcal Cellulitis in a Diabetic with Nephropathy on Adalimumab Therapy for Rheumatoid Arthritis

Yıl 2017, Cilt: 07 Sayı: 03, 160 - 163, 15.09.2017

Christine A. Moore Imranali Khan Almira Opardija

https://doi.org/10.5799/jmid.367623

Öz

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. 

Anahtar Kelimeler

Cryptococcus neoformans, rheumatoid arthritis, adalimumab, diabetes mellitus, chronic kidney disease

Kaynakça

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