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

J Gen Intern Med. 2018 May;33(5):769-772. doi: 10.1007/s11606-018-4383-0. Epub 2018 Mar 12.

Abstract

Biologic agents are effective treatments for rheumatoid arthritis but are associated with important risks, including severe infections. Tumor Necrosis Factor (TNF) α inhibitors are known to increase the risk of systemic fungal infections such as disseminated histoplasmosis. Abatacept is a biologic agent with a mechanism different from that of TNFα inhibitors: It suppresses cellular immunity by competing for the costimulatory signal on antigen-presenting cells. The risk of disseminated histoplasmosis for patients on abatacept is not known. We report a case of abatacept-associated disseminated histoplasmosis and review the known infectious complications of abatacept. While the safety of resuming biologic agents following treatment for disseminated histoplasmosis is also not known, abatacept is recommended over TNFα inhibitors for rheumatoid arthritis patients with a prior serious infection. We discuss the evidence supporting this recommendation and discuss alternative treatments for rheumatoid arthritis patients with a history of a serious infection.

Keywords: arthritis; drugs; infectious disease.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abatacept / administration & dosage
  • Abatacept / adverse effects*
  • Antirheumatic Agents / administration & dosage
  • Antirheumatic Agents / adverse effects*
  • Arthritis, Rheumatoid / drug therapy*
  • Female
  • Histoplasma / cytology
  • Histoplasma / isolation & purification
  • Histoplasmosis / blood
  • Histoplasmosis / chemically induced*
  • Histoplasmosis / diagnosis
  • Humans
  • Middle Aged

Substances

  • Antirheumatic Agents
  • Abatacept