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Fungal infections as a complication of therapy for sarcoidosis

R P Baughman1, E E Lower

  • 1Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA. bob.baughman@uc.edu

QJM : Monthly Journal of the Association of Physicians
|May 10, 2005
PubMed
Abstract

Insights

Invasive fungal infections are rare in sarcoidosis patients treated with immunosuppressants. A worsening chest X-ray may indicate a fungal infection requiring investigation.

Area of Science:

  • Pulmonology
  • Infectious Diseases
  • Immunology

Background:

  • Sarcoidosis treatment often involves immunosuppressive agents, increasing susceptibility to opportunistic infections.
  • Distinguishing fungal infections from sarcoidosis can be challenging.
  • Systemic immunosuppression is a key risk factor for invasive fungal infections.

Purpose of the Study:

  • To investigate the clinical presentation and management strategies for invasive fungal infections in patients with sarcoidosis.

Main Methods:

  • Retrospective review of medical records for 753 sarcoidosis patients over 18 months.
  • Analysis of diagnostic methods including bronchoscopy, lung biopsy, bone marrow aspirate, and spinal fluid examination.
  • Evaluation of patient treatments, including corticosteroids and methotrexate.

Main Results:

  • Seven sarcoidosis patients (0.9%) developed fungal infections (Histoplasma capsulatum, Blastomyces dermatitidis, Cryptococcus neoformans).
  • Fungal infections were diagnosed via bronchoscopy, lung biopsy, bone marrow aspirate, or spinal fluid.
  • All infected patients were on corticosteroids, and four were on methotrexate; none were on infliximab or cyclophosphamide.

Conclusions:

  • Invasive fungal infections are uncommon in sarcoidosis patients undergoing treatment.
  • Deterioration in chest X-ray findings, particularly localized infiltrates, necessitates prompt investigation for fungal infections.
  • Antifungal therapy combined with reduced immunosuppression led to positive patient outcomes.

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