Available information regarding coccidioidal infection in the setting of TNF-I is limited to few case reports and retrospective studies. The aim of our study was to determine the number of coccidioidomycosis seropositive patients identified on screening; and to describe what evaluation, treatment, and follow-up transpired for these individuals.
Methods: We electronically searched for all patients receiving TNF-I from 9/4/2010 to 4/22/2015. The records for seropositive patients were then reviewed in detail.
Results: 2218 individuals received TNF-I, 994 of whom had screening labs, and 837/994 (84%) had screening coccidioidal serologies performed. Of these, 66/837 (7.9%) were seropositive, and 55/837 (6.6%) met inclusion criteria. 19/55 (35%) were found on initial (pre-TNF-I) screening, 10/55 (18%) on annual screening, and 26/55 (47%) were identified when symptoms were evaluated. Of the 29 new diagnoses of coccidioidomycosis found on screening, 5 (17%) were diagnosed with probable coccidioidomycosis, 5 (17%) were diagnosed with possible coccidioidomycosis, 5 (17%) were diagnosed with asymptomatic seropositivity, and 14 (48%) were diagnosed with EIA IgM of uncertain significance. Of these, 8 (28%) had the initiation of their TNF-I postponed or, in those already on a TNF-I, had their medication discontinued. 12 (41%) were started on an anti-fungal at the time of their diagnosis. There were no cases of dissemination or reactivation in follow-up.
R. Heigh, None
J. Yiannias, None
J. Blair, None