A Case of Disseminated Histoplasmosis in a Patient with Rheumatoid Arthritis on Abatacept

Biologic agents are effective treatments for rheumatoid arthritis but are associated with important risks, including severe infections. Tumor Necrosis Factor (TNF) α inhibitors are known to increase the risk of systemic fungal infections such as disseminated histoplasmosis. Abatacept is a biologic a...

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Bibliographic Details
Published in:Journal of general internal medicine : JGIM 2018-05, Vol.33 (5), p.769-772
Main Authors: Jain, Nina, Doyon, Jeffrey B., Lazarus, Jacob E., Schaefer, Inga-Marie, Johncilla, Melanie E., Agoston, Agoston T., Dalal, Anuj K., Velásquez, Gustavo E.
Format: Article
Language:English
Subjects:
Abatacept - administration & dosage
Abatacept - adverse effects
Antigen-presenting cells
Antirheumatic Agents - administration & dosage
Antirheumatic Agents - adverse effects
Arthritis
Arthritis, Rheumatoid - drug therapy
Biological effects
Case reports
Cell-mediated immunity
Clinical Practice: Clinical Vignettes
Complications
Female
Health risks
Histoplasma - cytology
Histoplasma - isolation & purification
Histoplasmosis
Histoplasmosis - blood
Histoplasmosis - chemically induced
Histoplasmosis - diagnosis
Humans
Immunity
Infections
Inhibitors
Internal Medicine
Medicine
Medicine & Public Health
Middle Aged
Patients
Rheumatoid arthritis
T cell receptors
Tumor necrosis factor-TNF
Tumor necrosis factor-α
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Summary:Biologic agents are effective treatments for rheumatoid arthritis but are associated with important risks, including severe infections. Tumor Necrosis Factor (TNF) α inhibitors are known to increase the risk of systemic fungal infections such as disseminated histoplasmosis. Abatacept is a biologic agent with a mechanism different from that of TNFα inhibitors: It suppresses cellular immunity by competing for the costimulatory signal on antigen-presenting cells. The risk of disseminated histoplasmosis for patients on abatacept is not known. We report a case of abatacept-associated disseminated histoplasmosis and review the known infectious complications of abatacept. While the safety of resuming biologic agents following treatment for disseminated histoplasmosis is also not known, abatacept is recommended over TNFα inhibitors for rheumatoid arthritis patients with a prior serious infection. We discuss the evidence supporting this recommendation and discuss alternative treatments for rheumatoid arthritis patients with a history of a serious infection.
ISSN:0884-8734
1525-1497
DOI:10.1007/s11606-018-4383-0