Infliximab
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Histoplasmosis and Pneumocystis carinii pneumonia in a child: case report An 8-year-old boy developed histoplasmosis and Pneumocystis carinii pneumonia during treatment with infliximab for Crohn’s disease. The boy had received infliximab [route of administration not stated] at 5 mg/kg every 5–6 weeks for 15 months prior to the onset of night sweats, anorexia, cough and intermittent fevers. He was prescribed azithromycin empirically by his primary care physician. After initial improvement, his fevers spiked at 103.6° F and his abdominal pain and diarrhoea worsened over a 5-day period. He was referred to an emergency department. On presentation he was found to have hepatosplenomegaly and tests showed elevated inflammatory markers, mildly elevated transaminases and moderate anaemia. He was begun on metronidazole while awaiting stool culture results. The next day, a CT scan revealed hilar and peritracheal lymphadenopathy with necrotic portions throughout numerous lymph nodes as well as a diffuse reticular nodular density lacking calcification in both lungs. Investigation showed elevated serum angiotensinconverting enzyme and LDH levels and a positive urine histoplasma antigen. Silver staining of pathology specimens showed Pneumocystis carinii and biopsy tissue from a right sided hilar lymph node grew Histoplasma capsulatum. The boy received itraconazole and cotrimoxazole [trimethoprim/sulfamethoxazole]. Histoplasmosis antibodies for yeast and mycelia were increased and urine histoplasmosis antigen remained positive at 2 weekly follow ups. His appetite and cough improved and his fever resolved. His symptoms and chest x-ray normalised after about 4 weeks. Tschudy J, et al. Disseminated histoplasmosis and pneumocystis pneumonia in a child with crohn disease receiving infliximab. Journal of Pediatric Gastroenterology and Nutrition 51: 221-222, No. 2, Aug 2010. Available from: 803037152 URL: http://dx.doi.org/10.1097/mpg.0b013e3181c2c10d - USA
0114-9954/10/1318-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Reactions 11 Sep 2010 No. 1318
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