Concomitant disseminated histoplasmosis and disseminated tuberculosis after tumor necrosis factor inhibitor treatment: a case report

Muñoz-Oca, Juan E.; Morales, Martha Lissete Villarreal; Nieves-Rodriguez, Aracelis; Martínez-Bonilla, Lemuel

doi:10.1186/s12879-016-2097-7

Cited by 12 publications

(12 citation statements)

References 11 publications

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“…An alternative regimen including quinolones, like levofloxacin, can be done with adequate efficacy, and there are some reports with favorable outcomes in renal transplants [17]. In our case, the patient had a satisfactory evolution with the four-drug anti-TB medication (rifampin, isoniazid, pyrazinamide and ethambutol), associated with amphotericin B followed by itraconazole, not developing any relevant side effects that caused further harm.…”

Section: Discussionmentioning

confidence: 69%

Colonic Bleeding Due to Histoplasma and Mycobacterium Coinfection in Renal Transplant Patient

Oliveira¹,

Santana²,

Malave³

et al. 2018

JPP

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Abstract:Introduction: Histoplasmosis is a rare infectious condition caused by the fungus Histoplasma capsulatum that can be presented from asymptomatic to severe forms. Tuberculosis, still an endemic infection in some developing countries, can also have variable clinical presentations. Both diseases involve the lungs mostly, but in immunocompromised patients, especially those with advanced HIV infection and transplant patients, disseminated forms are more frequently found. Gastrointestinal involvement is unusual, and digestive bleeding is an even rarer complication. Case presentation: We report the case of a 39-year-old female who was diagnosed with a Mycobacterium tuberculosis and Histoplasma capsulatum coinfection occurring 11 years after a living-donor-related renal transplant. The patient presented a severe gastrointestinal bleeding caused by an ulcer in the ascending colon. She improved after a combined treatment with tuberculostatic and fungicidal drugs. Conclusions: Simultaneous gastrointestinal involvement by histoplasmosis and tuberculosis, presenting as severe digestive bleeding, with minimal respiratory symptoms associated, make this an extremely rare case and a diagnostic challenge. Therefore, it is important to keep a high clinical suspicion of opportunistic infection, especially in immunocompromised patient who presents with LGB.

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Section: Discussionmentioning

confidence: 69%

Colonic Bleeding Due to Histoplasma and Mycobacterium Coinfection in Renal Transplant Patient

Oliveira¹,

Santana²,

Malave³

et al. 2018

JPP

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“…The clinical syndrome of histoplasmosis usually begins with low-grade fevers and cough and is easily mistaken for community-acquired pneumonia [ [1] , [2] , [3] ]. When limited to the lungs, pulmonary histoplasmosis can be non-specific both clinically and on imaging.…”

Section: Discussionmentioning

confidence: 99%

“…The urine antigen is often detected at higher concentrations in immunocompromised patients with severe disseminated disease [ 5 ]. Unfortunately, not all institutions offer these assays and results can be delayed several days [ 3 ]. Therefore, a high index of suspicion is necessary for prompt diagnosis and management.…”

Section: Discussionmentioning

confidence: 99%

“…Given the context of possible substance abuse and homelessness, disseminated tuberculosis was considered as well. It is clinically difficult to distinguish between disseminated infections of histoplasmosis and tuberculosis given the initial symptoms, pulmonary involvement (cavitation and infiltration) and progression to pancytopenia and transaminitis [ 3 ]. Studies have suggested that tuberculosis presents less frequently than histoplasmosis in the setting of Tumor Necrosis Factor (TNF) inhibitors [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

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Cave diving for a diagnosis: Disseminated histoplasmosis in the immunocompromised

Mirza

Rodriguez

2018

IDCases

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“…Although immunosuppressive therapy can be highly effective for several immune-mediated diseases, tumor necrosis factor (TNF) inhibitors are associated with an increased risk of opportunistic infections, 1 including histoplasmosis and tuberculosis as well as clinical forms of cutaneous leishmaniasis (CL) and visceral infection (VL) and even a mucocutaneous form (ML). [2][3][4][5][6] Leishmaniasis, classed among the world's most neglected diseases, is a group of parasitic diseases caused by protozoa of the genus Leishmania.…”

Section: Introductionmentioning

confidence: 99%

Case Report: Diffuse Cutaneous Leishmaniasis by Leishmania infantum in a Patient Undergoing Immunosuppressive Therapy: Risk Status in an Endemic Mediterranean Area

Alcover

Rocamora

Guillén

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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This case report highlights the risk of severe cutaneous leishmaniasis (CL) by in patients undergoing immunosuppressant therapy who either live in an endemic area or are visiting in the transmission season. The case patient, resident in Majorca (Balearic Islands), presented 12 disseminated erythematous skin lesions, 1-6 cm in diameter, located on the scalp, cheek, umbilical region, and lower extremities 8 years after undergoing anti-tumor necrosis factor (TNF) therapy. Parasite presence in peripheral blood and high levels of specific antibodies were also observed, indicating a possible risk of CL shifting toward a visceral infection. However, once CL was diagnosed, anti-TNF therapy was discontinued and liposomal amphotericin B was administered, resulting in a complete healing of lesions, no DNA detection in blood, and an important serological decrease in antibodies. The lack of data on the supposed epidemiological association between leishmaniasis and immunosuppressive therapy highlights the importance of implementing surveillance systems in endemic areas. No obvious relationship was found based on the data provided by the Balearic Islands Epidemiological System, in contrast with data reported in nearby endemic areas. This indicates that if the suspected association is to be clarified, greater efforts are needed to report information about concomitant diseases and therapies in leishmaniasis patients.

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Concomitant disseminated histoplasmosis and disseminated tuberculosis after tumor necrosis factor inhibitor treatment: a case report

Cited by 12 publications

References 11 publications

Colonic Bleeding Due to Histoplasma and Mycobacterium Coinfection in Renal Transplant Patient

Colonic Bleeding Due to Histoplasma and Mycobacterium Coinfection in Renal Transplant Patient

Cave diving for a diagnosis: Disseminated histoplasmosis in the immunocompromised

Case Report: Diffuse Cutaneous Leishmaniasis by Leishmania infantum in a Patient Undergoing Immunosuppressive Therapy: Risk Status in an Endemic Mediterranean Area

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