Abstract / Summary
Tumor necrosis factor-alpha (TNF-α) is critical to the body's ability to mount an appropriate inflammatory and immune response to various infections, particularly against intracellular organisms.As such, the immunosuppressive effects associated with TNF-α inhibitors, such as etanercept, may increase susceptibility to opportunistic infections.We report a case of pulmonary Aspergillus infection in a 47-year-old female with rheumatoid arthritis receiving etanercept who was found to have underlying cystic bronchiectatic changes.The patient presented with progressive exertional dyspnea and was subsequently found to have right lower lobe cystic bronchiectatic changes with mass-like densities on computed tomography (CT) imaging.Sputum fungal culture was positive for Aspergillus, bronchoalveolar lavage (BAL) was positive for Aspergillus antigen, and fungal culture from a bronchoscopic biopsy specimen grew Aspergillus fumigatus.Other infectious evaluations were negative.The patient was treated with voriconazole, and etanercept was discontinued.This case highlights the diagnostic complexity of interpreting Aspergillus isolation in patients with underlying structural lung disease and TNF-α inhibitor exposure.