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Journal of Crohn's and Colitis: 9 (6)

Editor-in-Chief

Laurence J. Egan, Ireland

Associate Editors

Maria T. Abreu, USAShomron Ben-Horin, IsraelSilvio Danese, ItalyPeter Lakatos, HungaryMiles Parkes, UKGijs van den Brink, NLSéverine Vermeire, Belgium

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Pneumocystosis in a patient with Crohn's disease treated with combination therapy with adalimumab

Ana L. Desales , Jorge Mendez-Navarro , Luis J. Méndez-Tovar , Nayeli X. Ortiz-Olvera , Garret Cullen , Joaquín Ocampo , Willian Lemus , Amina E. Tun , Arturo Mayoral-Zavala , Margarita Dehesa-Violante
DOI: http://dx.doi.org/10.1016/j.crohns.2011.10.012 483-487 First published online: 1 May 2012

Abstract

Pneumocystis jirovecii pneumonia (PCP) is a potential complication of immunosuppression. Crohn's disease (CD) is an immune granulomatous disorder characterized by transmural inflammation that can affect any part of the gastrointestinal tract. Its treatment is based on steroids and immunosuppressants but in non-responders, biologic compounds such as anti-tumor necrosis factor alpha (TNF) antibodies have been used. Neutralization of TNF causes a decrease in the inflammatory response but increases susceptibility to opportunistic infections such as fungal infections.

We report a young male with chronic diarrhea, fever and weight loss who was diagnosed with CD and began conventional treatment with immunosuppressants, but due to lack of response after several weeks, biologic therapy with adalimumab was initiated. Seven weeks later he developed persistent fever and upper respiratory symptoms. After chest CT, bronchoscopy and bronchial lavage, P. jirovecii was identified by silver staining and confirmed by immunofluorescence. To our knowledge this is the second case of pneumocystosis associated with the use of adalimumab in CD and the first reported Mexican case confirmed by microbiological and immunological studies in this setting.

Keywords
  • PCP
  • Adalimumab
  • Crohn's disease
  • Pneumonia
  • Opportunistic infections
  • Anti-TNF
  • Abbreviations:
    PCP
    Pneumocystis jirovecii pneumonia
    CD
    Crohn's disease
    TNF
    tumor necrosis factor alpha
    ESR
    erythrocyte sedimentation rate
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