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Related Experiment Video

Updated: Jun 19, 2026

Isolation Protocol of Mouse Monocyte-derived Dendritic Cells and Their Subsequent In Vitro Activation with Tumor Immune Complexes
11:48

Isolation Protocol of Mouse Monocyte-derived Dendritic Cells and Their Subsequent In Vitro Activation with Tumor Immune Complexes

Published on: May 31, 2018

A rare trigger for macrophage activation syndrome.

Shikhar Agarwal1, Jayavani Moodley, Gati Ajani Goel

  • 1Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. dr.shikhar.agarwal@gmail.com

Rheumatology International
|October 17, 2009
PubMed
Summary

Macrophage activation syndrome (MAS) is a severe condition where immune cells attack blood cell precursors. This case highlights MAS triggered by disseminated histoplasmosis in a patient with Still’s disease on adalimumab therapy.

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Area of Science:

  • Immunology
  • Hematology
  • Infectious Diseases

Background:

  • Macrophage activation syndrome (MAS) is a life-threatening hyperinflammatory condition.
  • It involves the overactivation of macrophages and T-cells, leading to cytokine storm and hemophagocytosis.
  • MAS can be primary or secondary to various conditions, including infections and autoimmune diseases.

Observation:

  • A patient with Still's disease, treated with adalimumab, presented with disseminated histoplasmosis.
  • The patient subsequently developed MAS.
  • This suggests a potential link between adalimumab, histoplasmosis, and MAS development.

Findings:

  • Disseminated histoplasmosis can precipitate MAS in immunocompromised patients.
  • Adalimumab, a TNF-alpha inhibitor, may increase the risk of opportunistic infections like histoplasmosis, potentially triggering MAS.

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Whole-cell MALDI-TOF Mass Spectrometry is an Accurate and Rapid Method to Analyze Different Modes of Macrophage Activation
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Whole-cell MALDI-TOF Mass Spectrometry is an Accurate and Rapid Method to Analyze Different Modes of Macrophage Activation

Published on: December 26, 2013

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Last Updated: Jun 19, 2026

Isolation Protocol of Mouse Monocyte-derived Dendritic Cells and Their Subsequent In Vitro Activation with Tumor Immune Complexes
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Published on: May 31, 2018

Whole-cell MALDI-TOF Mass Spectrometry is an Accurate and Rapid Method to Analyze Different Modes of Macrophage Activation
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Whole-cell MALDI-TOF Mass Spectrometry is an Accurate and Rapid Method to Analyze Different Modes of Macrophage Activation

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  • This case underscores the importance of considering MAS in patients with underlying inflammatory conditions and new infections.

    • Implications:

    • Clinicians should maintain a high index of suspicion for MAS in patients with Still's disease on TNF-alpha inhibitors who develop disseminated infections.
    • Early diagnosis and prompt treatment of both the underlying infection and MAS are crucial for patient survival.
    • Further research is warranted to elucidate the precise mechanisms linking TNF-alpha inhibition, opportunistic infections, and MAS pathogenesis.