Disseminated cryptococcal infection in rheumatoid arthritis treated with methotrexate and infliximab
True, D.G.; Penmetcha, M.; Peckham, S.J.
Journal of Rheumatology 29(7): 1561-1563
2002
ISSN/ISBN: 0315-162X PMID: 12136922 Document Number: 544846
A case of rheumatoid arthritis (RA) and pancytopenia, complicated by disseminated Cryptococcus neoformans, while receiving low dose methotrexate (MTX) and infliximab is reported in a 69-year-old white man. The patient had a history of longstanding RA and type 2 diabetes mellitus [Texas, USA]. He had been receiving intramuscular gold until 1998 when therapy was changed to 10 mg/weekly oral MTX. He had received 5 infliximab infusions at 3 mg/kg dose at the time of initial evaluation. Examination revealed limited range of motion in the wrists and ankles and mild synovitis in the metacarpophalangeal joints. Computerized tomography showed multiple bilateral lung nodules and right lower lobe airspace diseases. Biopsy of a pulmonary lesion and blood cultures identified C. neoformans. MTX and infliximab were discontinued. He was intolerant of amphotericin B but responded well to fluconazole. Results show that more widespread clinical indications for TNF- alpha antagonists may increase the incidence of cryptococcosis in rheumatic disorders. Continued vigilance will be required to identify actual clinical risk of opportunistic infections associated with TNF- alpha inhibition.