Table 2 Clinical characteristics and treatment of 26 patients with rheumatoid arthritis who developed histoplasmosis

1

68/M

Adalimumab

48

Methotrexate, Prednisone

Lung

Serology

Itraconazole 3 months

2

60/M

Adalimumab

3

Hydroxychloroquine, Prednisone, Leflunomide

Lung

Serology

Itraconazole > 12 months

3

64/M

Adalimumab

2

None

Lung

Pathology (lung)

Amphotericin 2 weeks, voriconazole 3 months

4

62/M

Adalimumab

12

Methotrexate, Prednisone

Lung, liver

Culture (lung), pathology (lung), serology, urine antigen

Amphotericin 2 weeks, itraconazole > 12 months

5

47/F

Adalimumab

4

Methotrexate, Prednisone

Lung

Pathology (sputum), serology, urine antigen

Fluconazole 12 months

6

72/F

Adalimumab

15

Methotrexate

Lung, bone marrow, fungemia

Culture (sputum, bone marrow, blood), pathology (lung), serology, urine antigen

Amphotericin 2 weeks, voriconazole 10 weeks, itraconazole 12 months

7

47/F

Adalimumab

33

Methotrexate

Lung

Culture (sputum), serology, urine antigen

Itraconazole 16 weeks, transition to fluconazole 12 weeks (6 months total)

8

37/F

Etanercept

3

Methotrexate, Hydroxychloroquine

Lung

Serology

No treatment

9

47/F

Etanercept

2

Methotrexate

Lung

Serology

Itraconazole 1 week Voriconazole 12 months

10

59/M

Infliximab

12

Methotrexate, Prednisone, Leflunomide

Liver, fungemia

Culture (blood), pathology (liver), serology, urine antigen

Amphotericin 8 weeks, voriconazole 6 months transition to itraconazole > 12 months

11

73/F

Infliximab

24

Methotrexate, Prednisone

Bone marrow, fungemia

Culture (blood, bone marrow), serology

Itraconazole 3 months (follow up elsewhere)

12

32/M

Infliximab

18

Methotrexate, Hydroxychloroquine, Prednisone

Lung

Culture (sputum), pathology (lung), serology, urine antigen

Amphotericin 2 weeks, itraconazole > 12 months

13

68/F

Infliximab

36

Prednisone

Lung, small bowel

Culture (sputum, small bowel, peritoneum), pathology (small bowel) serology, urine antigen

Amphotericin 4 weeks, Itraconazole indefinitely

14

64/M

Infliximab

132

Azathioprine, Prednisone

Lung

Pathology (lung), serology

No treatment

15

53/F

Infliximab

56

Methotrexate

Lung

Serology, urine antigen

Voriconazole 1 week, Itraconazole 12 months

16

52/M

None

N/A

Methotrexate, Prednisone

Lung, bone marrow, fungemia

Culture (blood), pathology (bone marrow), serology, urine antigen

Amphotericin 1 week, Itraconazole 6 months

17

68/M

None

N/A

Methotrexate, Prednisone, Leflunomide

Lung

Serology

Itraconazole 5 months

18

68/M

None

N/A

Methotrexate, Prednisone

Lung, bone marrow

Culture (sputum), pathology (lung, bone marrow), serology, urine antigen

Itraconazole 12 months

19

70/M

None

N/A

Methotrexate, Prednisone, Leflunomide

Fungemia

Culture (blood)

Itraconazole 6 months

20

63/M

None

N/A

Methotrexate, Prednisone

Lung, Spleen

Culture (lung, sputum), serology, urine antigen

Itraconazole > 12 months

21

62/F

None

N/A

Methotrexate

Lung, fungemia

Culture (blood), serology

Amphotericin 2 weeks, itraconazole 12 months

22

78/M

None

N/A

Methotrexate, Prednisone

Lung

Culture (sputum), serology, urine antigen

Itraconazole 6 months

23

68/M

None

N/A

Methotrexate, Leflunomide, Minocycline

Lung, fungemia

Culture (blood), serology, urine antigen

Amphotericin 2 weeks, Itraconazole 12 months

24

35/F

None

N/A

None

Lung

Pathology (lung), serology

Itraconazole 3 months

25

75/M

None

N/A

Methotrexate, Hydroxychloroquine

Lung

Pathology (lung)

Itraconazole 6 weeks

26

45/F

None

N/A

Methotrexate, Hydroxychloroquine

Lung, liver

serology

Itraconazole 12 months