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Arquivos de Gastroenterologia

Print version ISSN 0004-2803

Abstract

PINHEIRO, Bruno do Valle; DELGADO, Áureo de Almeida  and  CHEBLI, Julio Maria Fonseca. HEPATITIS AND PNEUMONITIS DURIN ADALIMUMAB THERAPY IN CROHN’ DISEASE: mind the histoplasmosis!. Arq. Gastroenterol. [online]. 2014, vol.51, n.1, pp.73-76. ISSN 0004-2803.  https://doi.org/10.1590/S0004-28032014000100015.

Context

Tumor necrosis factor-alpha (TNF-α) inhibitor therapy plays a pivotal role in the management of moderate to severe inflammatory bowel disease. Because of the role of TNF-α in the host defenses, anti-TNF therapy has been associated with an increase the risks of granulomatous infections.

Objective

To report the first case of adalimumab-associated invasive histoplasmosis presenting as an acute hepatitis-like syndrome and febrile pneumonitis in a patient with Crohn’s disease.

Method

Case report of a patient with progressive histoplasmosis confirmed by percutaneous fine needle aspiration biopsy lung and urine Histoplasma antigen.

Results

We present the case of a young man with CD who developed pneumonia and acute hepatitis-like features caused by Histoplasma capsulatum infection during adalimumab therapy. To the best of our knowledge, this acute hepatitis-like manifestation has never been reported as a presentation of the histoplasmosis in patients with Crohn’s disease.

Conclusions

This case underscores the potential risk for serious infection that may arise in this setting and should alert clinicians to the need to consider the histoplasmosis diagnosis in patients presenting with acute hepatitis-like syndrome associated with prolonged febrile illness or pneumonitis during therapy with anti-TNF-α antibodies.

Keywords : Crohn disease; Tumor Necrosis Factor-alpha; Adalimumab; Histoplasmosis; Hepatitis.

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