Pulmonary Cryptococcosis in the Setting of Tofacitinib Therapy for Psoriasis

August 2015 | Volume 14 | Issue 8 | Case Reports | 901 | Copyright © August 2015


Lucia Seminario-Vidal MD PhD, Wendy Cantrell DNP, and Boni E. Elewski MD

Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL

a day of for approximately 8 months.6 The patient had several comorbidities that could have contributed to disease development including diabetes mellitus type 2, diverticulitis, allergic rhinitis, hypertension, hypercholesterolemia, sleep apnea, hepatic steatosis, dry eyes, and Ross river virus.6
Pulmonary cryptococcosis can occur in immunocompetent or immunocompromised individuals. It has been reported in 10% to 40% of patients with no apparent immunodeficiency.7 As is the case with most immunocompetent patients who develop symptomatic pulmonary cryptococcosis, our patient likely developed a primary infection that remained latent until his cell-mediated immunity was suppressed with tofacitinib and corticosteroids. This case illustrates that it is crucial to monitor for the subtle symptoms of cryptococcocal infection in the setting of tofacitinib therapy because delay of diagnosis may increase the risk of a life-threatening outcome.

DISCLOSURES

Dr. Seminario-Vidal has no conflicts of interest. Dr. Elewski is in the advisory board and an investigator for Novartis and Pfizer, and an investigator for Janssen, Merck, Lilly, Amgen and Abbvie. Dr. Cantrell has been an investigator for Pfizer Inc.

REFERENCES

  1. Bratton EW, El Husseini N, Chastain CA, et al. Comparison and Temporal Trends of Three Groups with Cryptococcosis: HIV-Infected, Solid Organ Transplant, and HIV-Negative/Non-Transplant. PLoS One. 2012;7
  2. Papp KA, Menter A, Strober B, et al. Efficacy and safety of tofacitinib, an oral Janus kinase inhibitor, in the treatment of psoriasis: a Phase 2b randomized placebo-controlled dose-ranging study. Br J Dermatol. 2012;167:668-77.
  3. Fleishman R, Kremer J, Cush John, et al. Placebo-Controlled Trial of Tofacitinib Monotherapy in Rheumatoid Arthritis. N Engl J Med. 2012; 367: 495-507.
  4. Yarilina A, Xu K, Chan C, et al. Regulation of inflammatory responses in tumor necrosis factor-activated and rheumatoid arthritis synovial macrophages by JAK inhibitors. Arthritis Rheum. 2012;64:3856-66.
  5. Ghoreschi K, Jesson MI, Li X, et al. Modulation of innate and adaptive immune responses by tofacitinib (CP-690,550). J Immunol. 2011;186: 4234-43.
  6. Kremer J, Li ZG, Hall S, et al. Tofacitinib in combination with nonbiologic disease-modifying antirheumatic drugs in patients with active rheumatoid arthritis: a randomized trial. Ann Intern Med. 2013;159: 253-61.
  7. Pappas PG, Perfect JR, Cloud GA, Larsen RA, Pankey GA, Lancaster DJ, et al. Cryptococcosis in human immunodeficiency virus-negative patients in the era of effective azole therapy. Clin Infect Dis. 2001;33:690-9.

AUTHOR CORRESPONDENCE

Boni E. Elewski MD……................................... belewski@uabmc.edu
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