RESUMO
BACKGROUND Infliximab, a monoclonal antibody against tumor necrosis factor (TNF) alpha with proven efficacy and known safety profile, is currently widely used in the treatment of inflammatory bowel diseases. Increased risk for serious infections and malignant neoplasms secondary to immunosuppression is a major concern during therapy with this medication. Histoplasmosis is a granulomatous disease caused by the fungus Histoplasma capsulatum. Disseminated forms of the disease have immunodepression as a major risk factor. CASE REPORT A 39-years-old man had been followed with refractory fistulizing ileocolonic Crohn's disease using combination therapy (infliximab plus azathioprine) and also receiving short courses of steroids. After 2 years of this immunosuppressive therapy, the patient presented with high fever (39.5ºC) for 5 days, associated with profuse sweating, and moderate pain in the left hypochondrium. The patient was hospitalized. Diagnoses of tuberculosis, malignancy, autoimmune diseases, and bacterial and viral infections were rapidly discarded after investigation. Clinical, laboratory, and image signs of liver involvement prompted a guided percutaneous biopsy, which revealed granulomatous hepatitis, with the presence of fungal structures suggestive of Histoplasma capsulatum. Upon treatment with liposomal amphotericin followed by itraconazole, the patient showed an impressively positive clinical response. CONCLUSIONS TNF blockers, particularly when associated with other immunosuppressors, are a serious risk factor for opportunistic infections. This unusual case of disseminated histoplasmosis in a patient with Crohn's disease using infliximab in combination with azathioprine and steroids emphasizes the need for surveillance of this uncommon but potentially lethal complication before starting TNF blockers therapy.
Assuntos
Doença de Crohn , Histoplasmose , Adulto , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Doença de Crohn/tratamento farmacológico , Histoplasma , Histoplasmose/diagnóstico , Humanos , Terapia de Imunossupressão , Infliximab/efeitos adversos , MasculinoRESUMO
This review aims to summarize the current evidence on the treatment of viral hepatitis, focusing on its clinical management. Also, future treatment options and areas of potential research interest are detailed. PubMed and Scopus databases were searched for primary studies published within the last ten years. Keywords included hepatitis A virus, hepatitis B virus (HBV), hepatitis C virus, hepatitis D virus (HDV), hepatitis E virus, and treatment. Outcomes reported in the studies were summarized, tabulated, and synthesized. Significant advances in viral hepatitis treatment were accomplished, such as the advent of curative therapies for hepatitis C and the development and improvement of hepatitis A, hepatitis B, and hepatitis E vaccination. Drugs that cure hepatitis B, going beyond viral suppression, are so far unavailable; however, targeted antiviral drugs against HBV (immunomodulatory therapies and gene silencing technologies) are promising approaches to eradicating the virus. Ultimately, high vaccination coverage and large-scale test-and-treat programmes with high screening rates may eliminate viral hepatitis and mitigate their burden on health systems. The development of curative hepatitis C treatment renewed the enthusiasm for curing hepatitis B, albeit further investigation is required. Novel therapeutic options targeting HDV life cycle are currently under clinical investigation.
Assuntos
Hepatite B , Hepatite C , Hepatite D , Antivirais/uso terapêutico , Hepatite B/diagnóstico , Hepatite B/tratamento farmacológico , Vírus da Hepatite B , Hepatite C/diagnóstico , Hepatite C/tratamento farmacológico , Hepatite D/diagnóstico , Hepatite D/tratamento farmacológico , Hepatite D/epidemiologia , Vírus Delta da Hepatite/genética , HumanosRESUMO
Disseminated strongyloidiasis (DS) is a rare and severe parasitic disease that is difficult to recognize and affects immunocompromised individuals. We report the case of a kidney transplant recipient who presented with DS despite prophylaxis with albendazole. We have discussed the need for better prophylactic strategies and for a higher degree of suspicion in order to diagnose DS.
Assuntos
Transplante de Rim , Complicações Pós-Operatórias/parasitologia , Estrongiloidíase/diagnóstico , Animais , Evolução Fatal , Humanos , Hospedeiro Imunocomprometido , Terapia de Imunossupressão/efeitos adversos , Masculino , Pessoa de Meia-Idade , Strongyloides stercoralis/isolamento & purificação , Estrongiloidíase/parasitologiaRESUMO
Disseminated strongyloidiasis (DS) is a rare and severe parasitic disease that is difficult to recognize and affects immunocompromised individuals. We report the case of a kidney transplant recipient who presented with DS despite prophylaxis with albendazole. We have discussed the need for better prophylactic strategies and for a higher degree of suspicion in order to diagnose DS.
A estrongiloidíase disseminada (ED) é uma doença parasitária rara de difícil diagnóstico que acomete indivíduos imunocomprometidos. Relatamos um caso de um paciente transplantado renal que desenvolveu ED apesar do uso de profilaxia com albendazol. São discutidas estratégias profiláticas e de diagnóstico da estrongiloidíase disseminada.