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Li X, Paccoud O, Chan KH, Yuen KY, Manchon R, Lanternier F, Slavin MA, van de Veerdonk FL, Bicanic T, Lortholary O. Cryptococcosis Associated With Biologic Therapy: A Narrative Review. Open Forum Infect Dis 2024; 11:ofae316. [PMID: 38947739 PMCID: PMC11212009 DOI: 10.1093/ofid/ofae316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/17/2024] [Indexed: 07/02/2024] Open
Abstract
Cryptococcus is an opportunistic fungal pathogen that can cause disseminated infection with predominant central nervous system involvement in patients with compromised immunity. Biologics are increasingly used in the treatment of neoplasms and autoimmune/inflammatory conditions and the prevention of transplant rejection, which may affect human defense mechanisms against cryptococcosis. In this review, we comprehensively investigate the association between cryptococcosis and various biologics, highlighting their risks of infection, clinical manifestations, and clinical outcomes. Clinicians should remain vigilant for the risk of cryptococcosis in patients receiving biologics that affect the Th1/macrophage activation pathways, such as tumor necrosis factor α antagonists, Bruton tyrosine kinase inhibitors, fingolimod, JAK/STAT inhibitors (Janus kinase/signal transducer and activator of transcription), and monoclonal antibody against CD52. Other risk factors-such as age, underlying condition, and concurrent immunosuppressants, especially corticosteroids-should also be taken into account during risk stratification.
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Affiliation(s)
- Xin Li
- Department of Infectious Diseases and Tropical Medicine, Université Paris Cité, Necker-Enfants Malades University Hospital, Assistance Publique–Hôpitaux de Paris, IHU Imagine, Paris, France
- Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Olivier Paccoud
- Department of Infectious Diseases and Tropical Medicine, Université Paris Cité, Necker-Enfants Malades University Hospital, Assistance Publique–Hôpitaux de Paris, IHU Imagine, Paris, France
| | - Koon-Ho Chan
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Kwok-Yung Yuen
- Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Romain Manchon
- Department of Infectious Diseases and Tropical Medicine, Université Paris Cité, Necker-Enfants Malades University Hospital, Assistance Publique–Hôpitaux de Paris, IHU Imagine, Paris, France
| | - Fanny Lanternier
- Department of Infectious Diseases and Tropical Medicine, Université Paris Cité, Necker-Enfants Malades University Hospital, Assistance Publique–Hôpitaux de Paris, IHU Imagine, Paris, France
- Institut Pasteur, National Reference Center for Invasive Mycoses and Antifungals, Mycology Translational Research Group, Mycology Department, Université Paris Cité, Paris, France
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia
| | - Frank L van de Veerdonk
- Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, the Netherlands
| | - Tihana Bicanic
- Institute of Infection and Immunity, St George's University of London, London, UK
| | - Olivier Lortholary
- Department of Infectious Diseases and Tropical Medicine, Université Paris Cité, Necker-Enfants Malades University Hospital, Assistance Publique–Hôpitaux de Paris, IHU Imagine, Paris, France
- Institut Pasteur, National Reference Center for Invasive Mycoses and Antifungals, Mycology Translational Research Group, Mycology Department, Université Paris Cité, Paris, France
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Hu M, Chai S, Lei W, Liao K, Zhang R. Mediastinal Small Cell Carcinoma with Primary Cutaneous Cryptococcosis: A Rare Case Report. Infect Drug Resist 2021; 14:3693-3697. [PMID: 34526789 PMCID: PMC8437414 DOI: 10.2147/idr.s325826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/02/2021] [Indexed: 12/19/2022] Open
Abstract
Cutaneous cryptococcosis, an infectious disease resulting from Cryptococcus neoformans, primarily affects immunodeficient individuals. Here, we report a case of mediastinal small cell carcinoma (MSCC) complicated with multiple skin and soft tissue infections mimicking erysipelas and cellulitis. Antibiotics for bacteria were ineffective and a culture of pus from the infected areas revealed Cryptococcus neoformans in this patient. The absence of any evidence indicative of systemic cryptococcal infection leads to a final diagnosis of primary cutaneous cryptococcosis (PCC). Following two weeks of fluconazole at 400 mg/day and 200 mg/day for the subsequent three months, combined with incision, irrigation and drainage, the wound gradually healed. An analysis and discussion of the clinical features of this patient are presented. This case alerts clinicians as to the possibility of Cryptococcus neoformans in patients with advanced malignant tumors complicated with multiple skin and soft tissue infections. While a timely diagnosis and treatment of PCC in this patient resulted in a favorable outcome, the patient succumbed to the malignant tumor at six months post-discharge.
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Affiliation(s)
- Mengjie Hu
- Department of Dermatology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
| | - Songling Chai
- Department of Oral and Maxillofacial Surgery, Stomatology College of Dalian Medical University, Dalian, Liaoning, People's Republic of China
| | - Wenyi Lei
- Department of Dermatology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
| | - Kexin Liao
- Department of Dermatology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
| | - Rongxin Zhang
- Department of Dermatology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
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Mauro FR, Giannarelli D, Visentin A, Reda G, Sportoletti P, Frustaci AM, Chiarenza A, Ciolli S, Vitale C, Laurenti L, De Paoli L, Murru R, Gentile M, Rigolin GM, Levato L, Giordano A, Del Poeta G, Stelitano C, Ielo C, Noto A, Guarente V, Molica S, Coscia M, Tedeschi A, Gaidano G, Cuneo A, Foà R, Martelli M, Girmenia C, Gentile G, Trentin L. Prognostic Impact and Risk Factors of Infections in Patients with Chronic Lymphocytic Leukemia Treated with Ibrutinib. Cancers (Basel) 2021; 13:3240. [PMID: 34209515 PMCID: PMC8269042 DOI: 10.3390/cancers13133240] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/12/2021] [Accepted: 06/13/2021] [Indexed: 12/16/2022] Open
Abstract
Ibrutinib represents extraordinary progress in the treatment of chronic lymphocytic leukemia (CLL). However, treatment-related adverse events limit the benefit of this agent. This observational, multicenter study focused on the incidence, risk factors, and prognostic impact of infections in 494 patients with CLL treated with an ibrutinib-based treatment. Ibrutinib was given to 89 (18%) previously untreated patients (combined with rituximab, 24) and 405 (82%) relapsed/refractory patients. Pneumonia (PN), grade ≥3 non-opportunistic infections (NOI), and opportunistic infections (OI) were recorded in 32% of patients with an overall incidence rate per 100 person-year of 15.3% (PN, 10%; NOI, 3.3%; OI, 2%). Infections were the reason for the permanent discontinuation of ibrutinib in 9% of patients. Patients who experienced pneumonia or a severe infection showed a significantly inferior survival than those who were infection-free (p < 0.0001). A scoring system based on the three factors associated with a significant and independent impact on infections-PN or severe infection in the year before starting ibrutinib, chronic obstructive pulmonary disease, ≥2 prior treatments-identified patients with a two- to threefold increase in the rate of infections. In conclusion, the results of this study highlight the adverse impact of infectious events on the outcomes of CLL patients treated with ibrutinib.
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Affiliation(s)
- Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, “Sapienza” University, 00161 Rome, Italy; (C.I.); (R.F.); (M.M.); (C.G.); (G.G.)
| | - Diana Giannarelli
- Biostatistic Unit, Regina Elena National Cancer Institute, IRCCS, 00144 Rome, Italy;
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, 35121 Padua, Italy; (A.V.); (L.T.)
| | - Gianluigi Reda
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.R.); (A.N.)
| | - Paolo Sportoletti
- Institute of Hematology-Centro di Ricerca Emato-Oncologica (CREO), Department of Medicine, University of Perugia, 06129 Perugia, Italy; (P.S.); (V.G.)
| | - Anna Maria Frustaci
- Deptartment of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy; (A.M.F.); (A.T.)
| | | | | | - Candida Vitale
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Turin, 10126 Turin, Italy; (C.V.); (M.C.)
| | - Luca Laurenti
- Institute of Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Lorenzo De Paoli
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy; (L.D.P.); (G.G.)
| | - Roberta Murru
- Haematology and Stem Cell Transplantation Unit, Ospedale Oncologico A. Businco, AO Brotzu, 09134 Cagliari, Italy;
| | - Massimo Gentile
- Hematology Unit, Hematology and Oncology Department, 87100 Cosenza, Italy;
| | - Gian Matteo Rigolin
- Hematology, Department of Medical Sciences, St. Anna University Hospital, 44124 Ferrara, Italy; (G.M.R.); (A.C.)
| | - Luciano Levato
- Haematology Unit, A. Pugliese Hospital, Azienda Ospedaliera Pugliese Ciaccio, 88100 Catanzaro, Italy; (L.L.); (S.M.)
| | - Annamaria Giordano
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology Section, University of Bari, 70124 Bari, Italy;
| | - Giovanni Del Poeta
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, 00133 Rome, Italy;
| | - Caterina Stelitano
- Division of Hematology, Azienda Ospedaliera Bianchi-Melacrino-Morelli, 89124 Reggio Calabria, Italy;
| | - Claudia Ielo
- Hematology, Department of Translational and Precision Medicine, “Sapienza” University, 00161 Rome, Italy; (C.I.); (R.F.); (M.M.); (C.G.); (G.G.)
| | - Alessandro Noto
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.R.); (A.N.)
| | - Valerio Guarente
- Institute of Hematology-Centro di Ricerca Emato-Oncologica (CREO), Department of Medicine, University of Perugia, 06129 Perugia, Italy; (P.S.); (V.G.)
| | - Stefano Molica
- Haematology Unit, A. Pugliese Hospital, Azienda Ospedaliera Pugliese Ciaccio, 88100 Catanzaro, Italy; (L.L.); (S.M.)
| | - Marta Coscia
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Turin, 10126 Turin, Italy; (C.V.); (M.C.)
| | - Alessandra Tedeschi
- Deptartment of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy; (A.M.F.); (A.T.)
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy; (L.D.P.); (G.G.)
| | - Antonio Cuneo
- Hematology, Department of Medical Sciences, St. Anna University Hospital, 44124 Ferrara, Italy; (G.M.R.); (A.C.)
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, “Sapienza” University, 00161 Rome, Italy; (C.I.); (R.F.); (M.M.); (C.G.); (G.G.)
| | - Maurizio Martelli
- Hematology, Department of Translational and Precision Medicine, “Sapienza” University, 00161 Rome, Italy; (C.I.); (R.F.); (M.M.); (C.G.); (G.G.)
| | - Corrado Girmenia
- Hematology, Department of Translational and Precision Medicine, “Sapienza” University, 00161 Rome, Italy; (C.I.); (R.F.); (M.M.); (C.G.); (G.G.)
| | - Giuseppe Gentile
- Hematology, Department of Translational and Precision Medicine, “Sapienza” University, 00161 Rome, Italy; (C.I.); (R.F.); (M.M.); (C.G.); (G.G.)
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, 35121 Padua, Italy; (A.V.); (L.T.)
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Pileri A, Guglielmo A, Agostinelli C, Evangelista V, Bertuzzi C, Alessandrini A, Bruni F, Starace M, Massi A, Broccoli A, Patrizi A, Zinzani PL, Piraccini BM. Cutaneous adverse-events in patients treated with Ibrutinib. Dermatol Ther 2020; 33:e14190. [PMID: 32790083 DOI: 10.1111/dth.14190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/30/2020] [Accepted: 08/08/2020] [Indexed: 12/13/2022]
Abstract
Ibrutinib is a Burton tyrosine kinase inhibitor (BTKi) approved for the treatment of several hematologic malignancies. Analyze skin adverse events (SAE). All the patients treated with Ibrutinib featuring cutaneous adverse events were selected. Twenty five patients were retrieved with a median interval between Ibrutinib start and SAE time of onset of 120 days. Most common SAE observed involved hairs and nails. Eczematous reaction and leucocytoclastic vasculitis were also detected. One patient had a long-history Ibrutinib treatment and experienced numerous cutaneous adverse events. Infective disease such as superficial mycosis and impetigo were rarely present in our series. Despite the development of cutaneous SAE, all the patients continued their concomitant drugs without the onset of any further SAE. Our data suggest Ibrutinib-associated rash should be distinguished in early and late events and a careful dermatologic management of patients should be scheduled.
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Affiliation(s)
- Alessandro Pileri
- Division of Dermatology Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italia
| | - Alba Guglielmo
- Division of Dermatology Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italia
| | - Claudio Agostinelli
- Division of Haematopathology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia
| | - Valeria Evangelista
- Division of Dermatology Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italia
| | - Clara Bertuzzi
- Division of Haematopathology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia
| | - Aurora Alessandrini
- Division of Dermatology Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italia
| | - Francesca Bruni
- Division of Dermatology Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italia
| | - Michela Starace
- Division of Dermatology Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italia
| | - Alice Massi
- Division of Dermatology Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italia
| | - Alessandro Broccoli
- Division of Hematology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia
| | - Annalisa Patrizi
- Division of Dermatology Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italia
| | - Pier Luigi Zinzani
- Division of Hematology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia
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