Remicade and Histoplasmosis

I read recently that taking remicade and imuran predisposes you to opportunistic infections from TB and histoplasmosis. While my TB was negative upon starting remicade, I am worried that a recent trip to the Bahamas where I did some cave hiking in heavily bat-infested caves may have exposed me to histoplasmosis. At the time, I was unaware of the risk. I don't know whether or not that area is has a problem with the disease or not. However, i read that it is a risk for people on remicade.

While noone who runs the tour group in the bahamas was familiar with the disease, I was wondering if it something to be concerned with. I have been experiencing respiratory symptoms of a bad cold, with bad headaches and pain. Is this something that doctors in the Mid Atlantic would even think about, or am I worrying for no reason. Is there anything to look for? Would my doctor even think to look for that?

thanks

[Kevin Pho, MD]

Hello - thanks for asking your question.

It is true that remicade may cause a possible reactivation of TB.  Other oppertunistic infections (such as histoplasmosis) can occur when you are taking this medication.  

The chest X-ray would be abnormal in 70 percent of patients with histoplasmosis.  There are several specific tests that are used for diagnosis.  Antigen testing is frequently used - either from the urine (90 percent of cases) or from the blood (70 percent of cases).

Fungal blood cultures should be performed in any suspected case.  Depending on your blood work, a bone marrow biopsy can also be performed for diagnosis.

In any case, I would follow-up with a pulmonary specialist for evaluation.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[caplanr]

What would be signs or symptoms of a problem. Or, should I get tested as precaution regardless?

[kevinmd]

Hello everyone,
I will be away until June 30th.  Have a nice weekend.

Kevin, M.D.

[patenglaender]

After 2 1/2 years on remicade, which is the ONLY RA medication that made me feel normal again, I was diagnosed with disseminated histoplasmosis. The swollen lympf nodes in my neck were very large, after two neck biopsy's and three months of waiting for a fungus to grow spores it actually took a DNA probe to diagnose the disseminated histoplasmosis. Subsuquently I was on the antibiotic itraconizole for over a year and my Rheumatologist refuses to let me back on remicade. Is there ANYONE else who had this fungal infection and was allowed back on remicade? If so did you have a reoccurence of the histoplasmosis? I'm desperate to get back on this medication because it worked so well for me. ANY informnation would be helpful to me!