Table 1.
Summary of immunosuppression management and disease outcomes.
| IBD type | Agea (years) | IBD therapy at time of histo diagnosis | IBD therapy discontinued at histo diagnosis | IBD therapy during histo treatment | IBD therapy after histo treatment | IBD ED visit?b | IBD admission?b | Antifungal regimen (duration in days) | Histo type |
|---|---|---|---|---|---|---|---|---|---|
| CD | 22 | 6MP + ADA | All | EEN for 12 months | Monitored w/o therapy | No | No | ITZ (367) | D |
| CD | 18 | IFX | All | 5ASA immediately | 5ASA continued | No | No | A + PSZ (459) | D |
| CD | 17 | 6MP + IFX | All | 5ASA immediately | 5ASA continued | No | No | ITZ (803) | D |
| CD | 17 | 6MP + IFX + Pred | All | Monitored w/o therapy |
IFX resumed after 12 months, 6MP resumed after 15 months |
Yes (403 days) |
Yes (367 days) |
ITZ (65) | P |
| UC | 18 | None | None | Monitored w/o therapy | Monitored w/o therapy | No | No | None | P |
| CD | 18 | MTX + ADA | All | EEN for 9 months |
ADA resumed after 9 months, MTX resumed after 12 mo |
No | No | A + ITZ (375) | D |
| CD | 17 | MTX | All | Monitored w/o therapy | Monitored w/o therapy | No | No | ITZ (113) | D |
| UC | 12 | MTX + IFX + Pred | All | 5ASA after 2 months | Monitored w/o therapy | No | No | A + ITZ (1048) | D |
| CD | 8 | MTX + IFX | All | Monitored w/o therapy | Monitored w/o therapy |
Yes (407 days) |
No | A + ITZ (487) | D |
| CD | 15 | MTX + IFX | All | EEN for 4 months then Vedo |
Vedo continued, IFX resumed after 21 months |
Yes (135 days) |
Yes (337 days) |
ITZ (647) | D |
| CD | 16 | ADA + 6MP + 5ASA | ADA + 6MP |
5ASA continued, ADA resumed after 9 months |
ADA continued | No | No | ITZ (204) | D |
| CD | 15 | IFX | All | 6MP after 2 months | 6MP continued | No |
Yes (367 days) |
A + ITZ (458) | P |
| UC | 9 | 6MP + IFX | IFX | 6MP continued |
6MP continued, 5ASA started after 2 months |
No | No | ITZ (481) | D |
| CD | 10 | IFX | All |
6MP after 1 month, IV steroids after 13 months |
6MP continued, total colectomy after 2 months |
Yes (279 days) |
Yes (44 days) |
ITZ (57) | D |
| CD | 16 | IFX + MTX | All | Monitored w/o therapy | ADA started after 17 months | No | No | ITZ (534) | D |
| CD | 15 | IFX + MTX | All | Monitored w/o therapy | Monitored w/o therapy | No | No | A + ITZ (540) | D |
| CD | 17 | IFX | None | IFX continued | IFX continued | No | No | ITZ (153) | L |
| CD | 16 | IFX | All | Vedo after 0.5 month |
Vedo continued; IFX resumed after 21 months |
No |
Yes (16 days) |
A + ITZ (371) | D |
| CD | 15 | IFX + MTX + 5ASA | All | Resumed all after 1.5 months | Continued all therapy | No | No | A + ITZ (374) | D |
Abbreviations: 5ASA, aminosalicylates; 6MP, mercaptopurine; A, patient initially treated with amphotericin; ADA, adalimumab; CD, Crohn's disease; D, disseminated histoplasmosis; EEN, exclusive enteral nutrition; histo, histoplasmosis; IBD, inflammatory bowel disease; IFX, infliximab; ITZ, itraconazole; L, lymphadenitis histoplasma; MTX, methotrexate; P, pulmonary histoplasmosis; PCZ, posaconazole; UC, ulcerative colitis; Vedo, vedolizumab.
Age at time of histoplasmosis diagnosis.
Days since histoplasmosis diagnosis.