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Pulmonary Cryptococcosis After Initiation of Anti-Tumor Necrosis Factor-α Therapy*

Chadi A. Hage; Karen L. Wood; Helen T. Winer-Muram; Stephen J. Wilson; George Sarosi; Kenneth S. Knox
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*From Pulmonary Critical Care (Drs. Hage, Wood, and Knox) and Infectious Diseases (Dr. Wilson), Department of Medicine (Dr. Sarosi), and the Department of Radiology (Dr. Winer-Muram), Indiana University School of Medicine, Indianapolis, IN.

Correspondence to: Kenneth S. Knox, MD, FCCP, Center for Sarcoidosis and Immunologic Lung Disease, Indiana University School of Medicine, 1001 West Tenth St, WD/OPW 425, Indianapolis, IN 46202; e-mail: kknox1@iupui.edu



Chest. 2003;124(6):2395-2397. doi:10.1378/chest.124.6.2395
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Many patients with rheumatoid arthritis are being treated with immunosuppressive regimens that include an agent directed at blocking tumor necrosis factor (TNF)-α. Although reportedly safe, tuberculous and fungal infections have emerged as significant complications of therapy. We report a case of pulmonary cryptococcosis soon after the initiation of therapy with the anti–TNF-α antibody, infliximab. A diagnosis was made early in the disease course, and the patient responded quickly to antifungal therapy. This case should alert clinicians to the increased incidence of pulmonary mycoses in patients receiving anti–TNF-α therapy.

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