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A Case of Disseminated Histoplasmosis in a Patient with Rheumatoid Arthritis on Abatacept

Nina Jain1, Jeffrey B Doyon1, Jacob E Lazarus1,2,3

  • 1Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.

Journal of General Internal Medicine
|March 14, 2018
PubMed

Insights

Biologic agents for rheumatoid arthritis carry infection risks. This study reports a rare case of disseminated histoplasmosis linked to abatacept, a biologic with a different mechanism than TNFα inhibitors.

Area of Science:

  • Rheumatology
  • Infectious Diseases
  • Immunology

Background:

  • Biologic agents, including Tumor Necrosis Factor (TNF) α inhibitors, are effective for rheumatoid arthritis (RA) but increase infection risks.
  • TNFα inhibitors are associated with systemic fungal infections like disseminated histoplasmosis.
  • Abatacept, a biologic agent, has a distinct mechanism of action suppressing cellular immunity.

Observation:

  • A case of disseminated histoplasmosis in a patient treated with abatacept is reported.
  • This case highlights a potential, previously unknown infectious complication of abatacept therapy.
  • Infectious complications associated with abatacept are reviewed.

Findings:

  • The risk of disseminated histoplasmosis with abatacept was previously unknown.
  • The study presents evidence of abatacept-associated disseminated histoplasmosis.
  • The safety of re-initiating biologics after disseminated histoplasmosis treatment remains unclear.

Implications:

  • Abatacept may be preferred over TNFα inhibitors for RA patients with a history of serious infections.
  • The findings inform treatment decisions for rheumatoid arthritis patients with significant infection histories.
  • Alternative RA treatments for patients with prior serious infections are discussed.
Keywords:
arthritisdrugsinfectious disease

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