Main Article Content
blastomycosis, adalimumab, psoraisis, humira, fungal
Blastomycosis is a dimorphic fungi endemic to the Ohio/Mississippi Rivers and the Great Lakes that can infect immunocompetent and immunosuppressed individuals. Systemic fungal infections, such as histoplasmosis or blastomycosis, have often been reported in patients taking TNF-α inhibitors such as adalimumab. However, blastomycosis is significantly less common than histoplasmosis and no cases have been described in the literature. We report a case of systemic blastomycosis associated with adalimumab and methotrexate use for psoriasis and psoriatic arthritis treatment that required extensive treatment and discontinuation of both medications. To our knowledge, this is the first case of systemic blastomycosis associated with adalimumab and methotrexate treatment for psoriasis to be described in the literature.
2. Kourbeti IS, Ziakas PD, Mylonakis E. Biologic Therapies in Rheumatoid Arthritis and the Risk of Opportunistic Infections: A Meta-analysis. Clinical Infectious Diseases. 2014;58(12):1649-1657.
3. Lee JH, Slifman NR, Gershon SK, et al. Life-threatening histoplasmosis complicating immunotherapy with tumor necrosis factor alpha antagonists infliximab and etanercept. Arthritis Rheum. 2002;46(10):2565-2570.
4. Crum NF, Lederman ER, Wallace MR. Infections Associated With Tumor Necrosis Factor-α Antagonists. Medicine. 2005;84(5):291-302.
5. Toussi SS, Pan N, Walters HM, Walsh TJ. Infections in children and adolescents with juvenile idiopathic arthritis and inflammatory bowel disease treated with tumor necrosis factor-α inhibitors: systematic review of the literature. Clin Infect Dis. 2013;57(9):1318-1330.
6. Baddley JW, Cantini F, Goletti D, et al. ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the safety of targeted and biological therapies: an infectious diseases perspective (Soluble immune effector molecules [I]: anti-tumor necrosis factor-α agents). Clin Microbiol Infect. 2018;24 Suppl 2:S10-s20.
7. Mathew G, Smedema M, Wheat LJ, Goldman M. Relapse of coccidioidomycosis despite immune reconstitution after fluconazole secondary prophylaxis in a patient with AIDS. Mycoses. 2003;46(1-2):42-44.
8. Wood KL, Hage CA, Knox KS, et al. Histoplasmosis after treatment with anti-tumor necrosis factor-alpha therapy. Am J Respir Crit Care Med. 2003;167(9):1279-1282.
9. Dewsnup DH, Galgiani JN, Graybill JR, et al. Is it ever safe to stop azole therapy for Coccidioides immitis meningitis? Ann Intern Med. 1996;124(3):305-310.
10. Lee MP, Wu KK, Lee EB, Wu JJ. Risk for deep fungal infections during IL-17 and IL-23 inhibitor therapy for psoriasis. Cutis. 2020;106(4):199-205.