Disseminated Histoplasmosis Successfully Treated with Liposomal Amphotericin B Following Azathioprine Therapy in a Patient from a Nonendemic Area

Abstract

Histoplasma infections in Europe are rare, and acute disseminated histoplasmosis has been observed only in immunocompromised persons. An unusual case of autochthonous disseminated histoplasmosis in a 22-year-old Spanish man who had been treated with azathioprine and prednisone for 4 weeks before admission is reported. The development of an acute form of the disease may represent an endogenous reactivation of a latent infection as a complication of immunosuppression resulting from the use of these drugs. This case illustrates the potential risk of this opportunistic fungal infection in patients receiving azathioprine therapy, an association that has been rarely described before.

Opportunistic infections in patients with inflammatory bowel disease: prevention and diagnosis

“…In the case of TNF antagonists, the risk of reactivating granulomatous diseases and infections, in which host defences are particularly macrophage dependent, is of particular concern. The prevalence and awareness of specific infections may vary from country to country, as it does, for instance, for Histoplasmosis in endemic or non-endemic regions 3 16 – 18. Recent safety concerns have focused on biological drugs, but it should be remembered that older traditional therapies have been less well scrutinised and that they all carry risks.…”