Opportunistic co-infection in a patient with Crohn's disease during infliximab (anti-TNFα) therapy

Background: The biological therapies for chronic inflammatory diseases of autoimmune origin, particularly drugs inhibiting cytokines, such as the antagonists of the tumoral necrosis factor alpha (TNF alpha), are acceptably well tolerated in patients suffering rheumatologic, dermatologic and gastrointestinal pathologies. Nevertheless, pharmacologic vigilance studies have clarified several aspects of their security in daily clinical use, The adverse effects associated with inhibitors of TNF alpha can be related to the target (or class) and to the agent. The adverse effects related to the target include those potentially attributable to the inherent immunosuppressive state due to the blockade of the main cytokine, phenomenon that could increase the susceptibility to the infections and cancer. Aims: To expound the potential risk of serious infections, opportunistic or not, inherent to the use of biological therapies and, specifically, antagonistic drugs of TNF alpha, from the description of a case of invasive fungal infection. Methods: Revision of clinical records, obtained from the chronic inflammatory disease of autoimmune origin patient database, candidates or recipients of the new biological therapies, and study of the microbiological isolates. Results: A case of dual opportunistic infection (nocardiosis and aspergillosis) with a difficult diagnosis and complex management in an immunosupressed patient with Crohn's disease, triggered off after the administration of infliximab (monoclonal antibody anti-TNF alpha) is presented. Conclusions: Invasive fungal infections, with isolated or associated clinical presentation to other opportunistic infections, are emerging in new groups-at-risk as they are the recipients of anti-cytokine biological therapies, regulators of inflammation and immunity. They can be potentially serious in their evolution and a high index of suspicion is needed sometimes for their prompt diagnosis. Possible preventive measures in patients with a high risk of suffering them will have to be investigated. (C) 2008 Revista Iberoamericana de Micologia. Published by Elsevier Espana, S.L. All rights reserved.