Case Report

Coccidioidomycosis Pneumonia in a Nonendemic Area Associated with Infliximab

Authors: Mahmood Dweik, MD, Bruce A. Baethge, MD, Alexander G. Duarte, MD

Abstract

Tumor necrosis factor (TNF) inhibitors, such as infliximab, are highly effective in the management of rheumatoid arthritis; however, these agents are associated with an increased risk of infectious complications. Individuals developing coccidiomycosis pneumonia frequently acquire this while residing in endemic regions. We present a patient with rheumatoid arthritis treated with infliximab who developed acute respiratory distress syndrome (ARDS) from coccidiomycosis pneumonia while residing in a nonendemic region near the Texas-Louisiana border and was successfully treated with antifungal therapy. The source for coccidiomycosis was suspected to be from inhalation of pulverized rock dust imported from Arizona. Patients treated with TNF inhibitors may acquire coccidiomycosis infection through fomite dust exposure.


Key Points


* Patients receiving infliximab are prone to the development of infectious complications.


* Coccidiomycosis pneumonia is a fungal infection previously noted to occur in patients residing in endemic regions while receiving TNF inhibitor therapy.


* In the present case, fomite-dust exposure was the most likely source for coccidiomycosis pneumonia.


* Before initiation of biologic therapies, patients considered as candidates for TNF inhibitor treatment should be screened for respiratory infections with a chest x-ray and Mantoux skin testing.

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