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• W2978045189 abstract "Infliximab is indicated for treatment of moderate to severe pediatric Crohn's disease. Although an effective therapy, there is an increased risk of serious infections. We present a case of a pediatric patient receiving infliximab who presented with disseminated histoplasmosis. Case Report: A 12-year-old male with history of ileocolonic Crohn's disease, stricturing type, presented to urgent care with a four-day history of fever, fatigue, and sore throat. He had been on infliximab and low-dose methotrexate for 11 months. Evaluation was unremarkable, except for mild transaminitis, and he was diagnosed with pneumonia. He was sent home with a diagnosis of atypical pneumonia. He continued to be febrile and was admitted to the inpatient service. Physical exam was remarkable for right upper quadant tenderness and hepatomegaly. Labs showed significant bandemia and persistently elevated transaminases. Repeat chest X-ray demonstrated right perihilar lymphadenopathy. Follow-up CT of chest revealed diffuse bilateral ground glass and nodular opacities, along with lymphadenopathy. Infectious work-up was initially negative, but urine Histoplasma antigen sent on admission was positive. Liver biopsy demonstrated non-caseating granulomatous hepatitis with fungal yeast forms and bone marrow biopsy was positive for yeast forms. Infliximab and methotrexate, which had been discontinued on admission, were not restarted and he was placed on maintenance enteral therapy. He was started on liposomal amphotericin B and transitioned to itraconazole one week later. He experienced a transient increase in his creatinine while on amphotericin B. With this treatment, his fevers subsided and transaminases began to improve within the first 3-5 days. After a decrease in his urine Histoplasma antigen and recurrence of his Crohn's disease, he was restarted on infliximab, without methotrexate. His transaminases began to increase shortly before his first infliximab infusion, but improved with a switch to fluconazole. He has been on infliximab for 5 months without recurrence of histoplasmosis and his Crohn's disease is in clinical remission. Conclusion: Use of infliximab has been shown to increase risk of opportunistic infections. The diagnosis of acute histoplasmosis can be made with urine antigen but requires a high index of suspicion in endemic regions. There is little data available on when and how to restart anti-TNF therapy." @default.
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• W2978045189 date "2016-10-01" @default.
• W2978045189 modified "2023-10-18" @default.
• W2978045189 title "Disseminated Histoplasmosis in a Pediatric Crohnʼs Patient on Infliximab Therapy" @default.
• W2978045189 doi "https://doi.org/10.14309/00000434-201610001-02036" @default.
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