Table 5.
Clinical Characteristics and Laboratory Findings of Patients Who Had Recurrent Disease
| Age, Sex, Disease | TNF-α Blocker, Duration Prior to Diagnosis | Diagnosis | Extent of Disease at Diagnosis | Treatment, Duration | TNF-α Blocker Resumed | Time to Recurrence | Diagnosis of Recurrence | Treatment of Recurrence, Outcome |
|---|---|---|---|---|---|---|---|---|
| 33 M Rheumatoid arthritis | Adalimumab, 27 mo | Positive BAL culture, lung granuloma, Urine Ag: 16.72 |
Moderate, pulmonary | Itraconazole for 8 mo, Urine Ag not retested prior to relapse | Yes at 6 mo | 8 mo, on antifungal | Fatigue, diaphoresis Urine Ag: 38.59 |
L-AmB, recovered |
| 54 F Rheumatoid arthritis | Adalimumab, unknown | Hepatic granuloma, Urine Ag: 13.01 | Moderate, disseminated | L-AmB for 4 wk, then voriconazolea for 6 mo Urine Ag: 2.17 at 12 mo |
No | 14 mo, off antifungal | Fever, cough Urine Ag: 4.76 |
Voriconazole, recovered |
| 33 F Crohn disease | Infliximab, 40 mo | Positive serology, Urine Ag: 3.26 | Mild, disseminated | Itraconazole, 6 mo Urine Ag: negative at 9 mo |
Yes at 6 mo | 39 mo, off antifungal | Fulminant sepsis, Urine Ag: >19 | L-AmB, died |
TNF-α blocker was initially discontinued in all patients. Antigen levels are in ng/mL.
Abbreviations: Ag, antigen; BAL, bronchoalveolar lavage fluid; L-amB, liposomal amphotericin B; TNF, tumor necrosis factor.
a The patient did not tolerate itraconazole.