HEPATITIS AND PNEUMONITIS DURIN ADALIMUMAB THERAPY IN CROHN’ DISEASE: mind the histoplasmosis!

Pinheiro, Bruno Valle; Delgado, Áureo de Almeida; Chebli, Júlio Maria Fonseca

doi:10.1590/s0004-28032014000100015

Cited by 10 publications

(8 citation statements)

References 14 publications

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“…The diagnosis in both cases was established by tissue sampling. Despite the majority of literature reporting cases of granulomatous hepatitis in immunocompromised patients [15][16][17][18], the workup of our patient was negative to tests that would indicate immunodeficiency, such as HIV, autoimmune, and chronic medical conditions.…”

Section: Discussioncontrasting

confidence: 62%

“…To our knowledge, there are very few cases in the literature describing granulomatous hepatitis due to histoplasmosis, especially in immunocompetent adults [13][14][15][16][17][18]. One case reported a previously healthy man who presented with fever, hepatomegaly, and anorexia and was found to have granulomatous hepatitis due to acute histoplasmosis [13].…”

Section: Discussionmentioning

confidence: 99%

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Granulomatous Hepatitis Secondary to Histoplasmosis in an Immunocompetent Patient

Muhanna¹,

Nimri²,

Almomani³

et al. 2021

Cureus

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Histoplasma capsulatum is the most common endemic mycosis in the United States and usually occurs in certain geographic areas, such as the Mississippi or Ohio River valleys. Histoplasmosis usually causes a mild disease in the immunocompetent but can progress to disseminated disease in patients with impaired immunity. Granulomatous hepatitis as a manifestation of disseminated histoplasmosis in immunocompetent patients is extremely rare. We report the case of a 62-year-old immunocompetent gentleman with a history of histoplasmosis who presented with abdominal pain, elevated liver enzymes, who was diagnosed with granulomatous hepatitis secondary to histoplasmosis.

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Section: Discussioncontrasting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Granulomatous Hepatitis Secondary to Histoplasmosis in an Immunocompetent Patient

Muhanna¹,

Nimri²,

Almomani³

et al. 2021

Cureus

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“…Thus, when an individual, especially in the setting of an immunocompromised state, presents with fever and jaundice, this disease entity should be considered or ruled out. Of the 123 cases, 16 had granulomatous hepatitis with six having coexisting cholecystitis [ 22 , 32 , 34 , 47 , 54 , 56 , 61 , 67 , 68 , 72 , 73 , 76 , 83 , 97 , 114 , 118 ]. Of the 16, 11 were immunocompromised secondary to HIV infection (n = 3) [ 68 , 72 , 114 ], post-transplantation on immunosuppressive therapy (n = 2) [ 61 , 72 ] and some were on immunosuppressive therapy for various ailments (n = 6), azathioprine [ 32 , 76 ], methotrexate [ 34 , 73 , 118 ], steroids [ 32 , 34 , 118 ], infliximab [ 32 , 73 ], fingolimod [ 54 ], mycophenolate, adalimumab [ 76 , 118 ], mesalazine [ 76 ] and the remainder were immunocompetent [ 22 , 47 , 56 , 67 , 97 ].…”

Section: Discussionmentioning

confidence: 99%

“…Of the 123 cases, 16 had granulomatous hepatitis with six having coexisting cholecystitis [ 22 , 32 , 34 , 47 , 54 , 56 , 61 , 67 , 68 , 72 , 73 , 76 , 83 , 97 , 114 , 118 ]. Of the 16, 11 were immunocompromised secondary to HIV infection (n = 3) [ 68 , 72 , 114 ], post-transplantation on immunosuppressive therapy (n = 2) [ 61 , 72 ] and some were on immunosuppressive therapy for various ailments (n = 6), azathioprine [ 32 , 76 ], methotrexate [ 34 , 73 , 118 ], steroids [ 32 , 34 , 118 ], infliximab [ 32 , 73 ], fingolimod [ 54 ], mycophenolate, adalimumab [ 76 , 118 ], mesalazine [ 76 ] and the remainder were immunocompetent [ 22 , 47 , 56 , 67 , 97 ]. Investigations revealed markedly elevated liver enzymes with coexisting gall bladder disorder [ 22 , 44 , 54 , 67 , 68 , 118 ] and enlarged liver [ 32 , 34 , 68 , 83 ].…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal Histoplasmosis: A Descriptive Review, 2001–2021

Ekeng

Itam-Eyo

Osaigbovo

et al. 2023

Life

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Gastrointestinal histoplasmosis (GIH) is infrequently described in people without underlying HIV infection. We aimed to compare the clinical presentation of GIH in people with and without HIV infection. We conducted a literature search of published cases of GIH from 2001–2021 and found 212 cases. Of these, 142 (67.0%) were male, and 124 (58.5%) had HIV infection. Most cases were from North America (n = 88, 41.5%) and South America (n = 79, 37.3%). Of the 212 cases, 123 (58.0%) were included in both clinical and pathological analyses. The remainder were excluded as details about clinical and pathological findings were not available. Of the 123 cases, 41 had HIV infection while 82 were without HIV infection. The diagnosis was predominantly by histopathology (n = 109, 88.6%). A significant proportion of people with HIV infection had abdominal pain as the most predominant symptom of GIH compared to those without HIV infection (65.9% versus 41.9%, p < 0.05). The colon was the most affected site with a slightly higher proportion in those with HIV infection compared with cases without HIV infection (46.3% versus 42.7%). The commonest pathologic findings were caecal and ileal ulcers. Caecal ulcers were significantly more frequent in cases with HIV infection compared to those without HIV (32.1% versus 7.1%, p < 0.05). Despite being more common in people with HIV infection, GIH also affects people without HIV infection with similar clinical presentations.

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“…Histoplasma capsulatum is acquired through inhalation of spores from environmental sources, often following exposure to disturbed soil contaminated with bird or bat droppings. The fungus primarily affects the lungs but dissemination to multiple other organs can occur, particularly in patients with impaired cell-mediated immunity 2. Treatment guidelines for management of histoplasmosis in the setting of Crohn’s disease are not well established with regard to duration of antifungal treatment or management of immunosuppression.…”

Section: Introductionmentioning

confidence: 99%

Histoplasma meets Crohn’s disease: a rare case of new-onset ascites

Bosshardt

Gnann

Lodhia³

2018

BMJ Case Reports

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A 53-year-old man with Crohn's disease treated with adalimumab was hospitalised with abdominal pain, fatigue, fever and chills. CT scan of the abdomen showed chronic thickening of the terminal ileum and cecum and new-onset ascites. Further studies revealed weakly positive urine and serum histoplasma antigen. Laparoscopy revealed metastatic caking of the omentum and abdominal wall; peritoneal biopsy demonstrated organisms morphologically consistent with No dissemination outside of the peritoneal cavity was evident. The patient completed 2 weeks of liposomal amphotericin B followed by oral itraconazole for 1 year. Adalimumab therapy was held for 10 weeks, then restarted. Presenting symptoms resolved following initiation of antifungal therapy. Follow-up MRI of his abdomen demonstrated resolution of ascites. To our knowledge, this is the first reported case of histoplasmosis presenting as peritonitis in a patient with Crohn's disease receiving antitumour necrosis factor-alpha (TNF-α) therapy. Many clinicians are aware that patients receiving anti-TNF-α therapy are at increased risk for histoplasmosis, but may fail to consider the diagnosis in the absence of lung involvement.

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HEPATITIS AND PNEUMONITIS DURIN ADALIMUMAB THERAPY IN CROHN’ DISEASE: mind the histoplasmosis!

Cited by 10 publications

References 14 publications

Granulomatous Hepatitis Secondary to Histoplasmosis in an Immunocompetent Patient

Granulomatous Hepatitis Secondary to Histoplasmosis in an Immunocompetent Patient

Gastrointestinal Histoplasmosis: A Descriptive Review, 2001–2021

Histoplasma meets Crohn’s disease: a rare case of new-onset ascites

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