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Made available in DSpace on 2021-06-25T10:53:42Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-06-01 Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Paracoccidioidomycosis (PCM) is a systemic granulomatous fungal infection rarely associated with solid organ transplantation. We report the second case of PCM in an adult after liver transplantation. A 47-year-old woman who had undergone liver transplantation was hospitalized for flu-like symptoms and multiple erythematous ulcerated skin papules. There was lymphadenopathy, pulmonary compromise, and quickly progression to septic shock. PCM was confirmed by skin biopsy and serologic tests, and a satisfactory response to amphotericin B was achieved. Department of Internal Medicine Gastroenterology Division - São Paulo State University (UNESP) Botucatu Medical School, Rubião Júnior S/N Department of Internal Medicine Hematology Division - São Paulo State University (UNESP) Botucatu Medical School, Rubião Júnior S/N Department of Pathology - São Paulo State University (UNESP) Botucatu Medical School, Rubião Júnior S/N Department of Tropical Diseases and Diagnostic Imaging - São Paulo State University (UNESP) Botucatu Medical School, Rubião Júnior S/N Department of Internal Medicine Gastroenterology Division - São Paulo State University (UNESP) Botucatu Medical School, Rubião Júnior S/N Department of Internal Medicine Hematology Division - São Paulo State University (UNESP) Botucatu Medical School, Rubião Júnior S/N Department of Pathology - São Paulo State University (UNESP) Botucatu Medical School, Rubião Júnior S/N Department of Tropical Diseases and Diagnostic Imaging - São Paulo State University (UNESP) Botucatu Medical School, Rubião Júnior S/N FAPESP: 2017/25592-9

Made available in DSpace on 2022-04-29T08:33:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Background: Challenging differential diagnosis Adalimumab is a biological anti-tumor necrosis factor (TNF) agent which induces and maintains remission in patients with moderate-to-severe Crohn disease (CD). An adverse effect of its use is reactivation of latent in-fections, such as tuberculosis (TB). TB is caused by Mycobacterium tuberculosis and continues to be an impor-tant public health problem in some developing countries, such as Brazil. The present report describes the case of a patient with CD who developed pulmonary TB while receiving adalimumab therapy. A 38-year-old penitentiary worker presented with colonic CD that was intolerant to azathioprine and was started on adalimumab. After 3 months, he experienced coughing, fever, and weight loss, and was diagnosed with pulmonary TB. A chest X-ray and tuberculin skin test performed before he started taking adalimumab were negative for latent TB. The patient was treated for 9 months to cure his infection. The use of adalimumab was suspended while the TB was investigated and he took mesalazine to achieve clinical and endoscopic remission of CD. Adequate screening and chemoprophylaxis for latent TB are indicated in patients at high risk of infection. In patients with inflammatory bowel disease, after anti-TNF therapy is started, strict monitoring is required so that opportunistic infections can be detected early and morbidity and mortality reduced in this population. Department of Internal Medicine São Paulo State University (UNESP) Medical School Department of Radiology São Paulo State University (UNESP) Medical School Department of Surgery São Paulo State University (UNESP) Medical School Department of Internal Medicine São Paulo State University (UNESP) Medical School Department of Radiology São Paulo State University (UNESP) Medical School Department of Surgery São Paulo State University (UNESP) Medical School