Localized Histoplasmosis During Treatment With Adalimumab

Background: Histoplasmosis is an opportunistic systemic micosis. In Argentina, the basin of the Río de la Plata is the most prevalent área. Lung involvement is the most frequent form of presentation and most patients have disseminated at the time of diagnosis, being the extrapulmonary manifestation exceptional. In immunosuppressed individuals both infected with human immunodeficiency virus and those treated with biological agents increased risk of developing disseminated histoplasmosis with severe symptoms that can lead to death. Methods & Materials: He was treated with methotrexate (Mtx) until July 2013, with remission and subsequent suspension of medication. He presented joint regrowth in January 2014, for which he restarted treatment. In September 2015, he presented uveitis, which is why he started treatment with Adalimumab (anti-TNF); being clinically inactive in April 2016. In July 2017, the patient complained of granulomatous formation on the hard palate and tumor in the right nostril, without general symptoms. Results: Metotrexate and adalimumab were discontinued. Magnetic resonance of the facial massif was performed, demonstrating the presence of an inflammatory lesion on the hard palate without bone invasion. As for the nasal mass, it was recognized as a polypoid formation arising from one of the turbinates. Chest and abdominal scans were normal. In August of 2017, surgery was performed on both lesions. The microbiological culture of the lesion was negative for common bacteria and mycobacteria. In the mycological culture, Histoplasma capsulatum was isolated. Treatment was carried out with itraconazole. Conclusion: Therapy with tumor necrosis factor blockers has revolutionized the treatment of various autoimmune disorders, but the Histoplasmosis can complicate the treatment, Worldwide, in the pediatric population, there are no published cases of presentation with granulomatous compromise on the hard palate associated with nasal polypoid mass in the absence of disseminated disease and pulmonary compromised