PMID- 24760069
OWN - NLM
STAT- MEDLINE
DCOM- 20141112
LR  - 20191112
IS  - 1678-4219 (Electronic)
IS  - 0004-2803 (Linking)
VI  - 51
IP  - 1
DP  - 2014 Jan-Mar
TI  - Hepatitis and pneumonitis during adalimumab therapy in Crohn disease: mind the 
      histoplasmosis!
PG  - 73-6
LID - S0004-28032014000100073 [pii]
AB  - CONTEXT: Tumor necrosis factor-alpha (TNF-alpha) inhibitor therapy plays a pivotal 
      role in the management of moderate to severe inflammatory bowel disease. Because 
      of the role of TNF-alpha in the host defenses, anti-TNF therapy has been associated 
      with an increase the risks of granulomatous infections. OBJECTIVE: To report the 
      first case of adalimumab-associated invasive histoplasmosis presenting as an 
      acute hepatitis-like syndrome and febrile pneumonitis in a patient with Crohn's 
      disease. METHOD: Case report of a patient with progressive histoplasmosis 
      confirmed by percutaneous fine needle aspiration biopsy lung and urine 
      Histoplasma antigen. RESULTS: We present the case of a young man with CD who 
      developed pneumonia and acute hepatitis-like features caused by Histoplasma 
      capsulatum infection during adalimumab therapy. To the best of our knowledge, 
      this acute hepatitis-like manifestation has never been reported as a presentation 
      of the histoplasmosis in patients with Crohn's disease. CONCLUSIONS: This case 
      underscores the potential risk for serious infection that may arise in this 
      setting and should alert clinicians to the need to consider the histoplasmosis 
      diagnosis in patients presenting with acute hepatitis-like syndrome associated 
      with prolonged febrile illness or pneumonitis during therapy with anti-TNF-alpha 
      antibodies.
FAU - Pinheiro, Bruno do Valle
AU  - Pinheiro Bdo V
AD  - Divisao de Pneumologia, Departamento de Medicina, Hospital da Universidade 
      Federal de Juiz de Fora, Juiz de Fora, MG, Brasil.
FAU - Delgado, Aureo de Almeida
AU  - Delgado Ade A
AD  - Departamento de Medicina, Hospital Santa Casa, Juiz de Fora, MG, Brasil.
FAU - Chebli, Julio Maria Fonseca
AU  - Chebli JM
AD  - Divisao de Gastroenterologia, Departamento de Medicina, Centro de Doencas 
      Inflamatorias Intestinais, Hospital da Universidade Federal de Juiz de Fora>, 
      Juiz de Fora, MG, Brasil.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - Brazil
TA  - Arq Gastroenterol
JT  - Arquivos de gastroenterologia
JID - 15310600R
RN  - 0 (Anti-Inflammatory Agents)
RN  - 0 (Antibodies, Monoclonal, Humanized)
RN  - FYS6T7F842 (Adalimumab)
SB  - IM
MH  - Acute Disease
MH  - Adalimumab
MH  - Adult
MH  - Anti-Inflammatory Agents/*adverse effects
MH  - Antibodies, Monoclonal, Humanized/*adverse effects
MH  - Crohn Disease/drug therapy
MH  - Hepatitis/*etiology
MH  - Histoplasmosis/*chemically induced
MH  - Humans
MH  - Male
MH  - Pneumonia/*chemically induced
EDAT- 2014/04/25 06:00
MHDA- 2014/11/13 06:00
CRDT- 2014/04/25 06:00
PHST- 2013/09/09 00:00 [received]
PHST- 2013/10/28 00:00 [accepted]
PHST- 2014/04/25 06:00 [entrez]
PHST- 2014/04/25 06:00 [pubmed]
PHST- 2014/11/13 06:00 [medline]
AID - S0004-28032014000100073 [pii]
AID - 10.1590/s0004-28032014000100015 [doi]
PST - ppublish
SO  - Arq Gastroenterol. 2014 Jan-Mar;51(1):73-6. doi: 10.1590/s0004-28032014000100015.