BACKGROUND The advent of tumor necrosis factor-α (TNF-α) inhibitor therapy has transformed inflammatory bowel disease management; however, these medications carry a boxed warning for risk of serious infections, including invasive fungal infections. AIMS We aimed to study the clinical features, severity, and outcomes of histoplasmosis in patients on TNF-α inhibitors for IBD. METHODS We performed a retrospective review of IBD patients receiving TNF-α inhibitors who developed histoplasmosis from January 1, 2001, to May 31, 2018. Patients with drug indications other than ulcerative colitis or Crohn's disease were excluded. IBD was diagnosed histologically, radiographically, or endoscopically. RESULTS We identified 49 patients (median age 44 years; range 19-76) with histoplasmosis on TNF-α inhibitors. Patients with disseminated disease had a median urine antigen of 10.76 ng/mL compared with pulmonary disease alone 0.375 ng/mL (p < 0.001). Charlson Comorbidity Index and urine antigen levels showed a trend toward predicting disease severity (p > 0.05). Median length of stay was 9.5 days. Itraconazole was used for maintenance in all patients. Median follow-up was 4.7 years. Total treatment duration ranged from 3 to 15 months. TNF-α inhibitor therapy was continued in nine and resumed in ten patients after completing antifungals. Three deaths occurred (6%). CONCLUSIONS Histoplasmosis outcomes were mostly favorable. Many patients were young with few comorbidities; however, those with more comorbidities experienced more severe histoplasmosis. Compared to prior studies, many of these patients resumed or continued biologic therapy. There were no histoplasmosis recurrences after resuming TNF-α inhibitor therapy. Vigilance for disseminated fungal infections in this patient population is essential.

中文翻译：

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具有肿瘤坏死因子-α抑制剂的炎性肠病中的组织胞浆菌病：是否可以继续使用生物制剂？

背景技术肿瘤坏死因子-α（TNF-α）抑制剂疗法的出现改变了炎症性肠病的治疗方法。然而，这些药物带有框框警告，提示存在严重感染风险，包括侵入性真菌感染。目的我们旨在研究使用IBD的TNF-α抑制剂的患者的组织胞浆菌病的临床特征，严重程度和结局。方法我们对2001年1月1日至2018年5月31日发生组织胞浆菌病的接受TNF-α抑制剂的IBD患者进行了回顾性研究。排除了除溃疡性结肠炎或克罗恩病以外的药物适应症的患者。IBD是通过组织学，影像学或内镜诊断的。结果我们确定了49名患者（中位年龄为44岁；范围为19-76）患有TNF-α抑制剂的组织胞浆菌病。散发性疾病患者的中位尿液抗原为10.76 ng / mL，而单独的肺部疾病为0.375 ng / mL（p <0.001）。查尔森合并症指数和尿液抗原水平显示出预测疾病严重程度的趋势（p> 0.05）。平均住院天数为9.5天。伊曲康唑用于所有患者的维持。中位随访时间为4。7年。总治疗时间为3到15个月。在完成抗真菌治疗后，九名患者继续进行TNF-α抑制剂治疗，十名患者中恢复治疗。发生了三人死亡（6％）。结论组织胞浆菌病的结果大部分是有利的。许多患者年轻，合并症很少；然而，合并症更多的人会经历更严重的组织胞浆菌病。与先前的研究相比，这些患者中有许多恢复或继续进行生物治疗。恢复TNF-α抑制剂治疗后无组织胞浆菌病复发。在该患者人群中对传播的真菌感染保持警惕是至关重要的。