The effects of itraconazole on inflammatory bowel disease activity in patients treated for histoplasmosis
E-mail: firstname.lastname@example.org SIRS, We read with interest the article by Schneeweiss and colleagues studying the risk of bacterial infections in patients treated with infliximab for the treatment of inflammatory bowel disease (IBD).1
We would like to share with the readers some interesting observations following a retrospective database review of histoplasmosis in IBD patients on immunosuppressive treatment.
Between 2000 and 2009, six patients with moderate-to-severe IBD (five Crohn’s disease and one ulcerative colitis) developed histoplasmosis as a consequence of their immunosuppressive regime and received treatment with itraconazole (an azole antifungal agent) and withdrawal of immunosuppression.
Four of the six patients (67%) were in clinical and endoscopic remission at the end of itracona- zole therapy (6 months median treatment duration) despite being off their immunosuppression (Table 1). The two patients whose IBD was active at the time of initiation of treatment had complete clinical and endoscopic response after 6 and 9 months of itraconazole treatment respectively (Table 1).
Majority of our Crohn’s patients had previously experienced intestinal complications (fistulas and⁄or strictures), and had required multiple prior surgical resections suggesting an aggressive natural history. Despite this, and in the absence of continued biolog- ical and⁄or immunosuppressive therapy, they were able to withdraw immuno- suppression and anti-TNF-a therapy during the entire itraconazole treatment course and the time to relapse in two of the Crohn’s patients was at least 10 months post-itraconazole therapy (Table 1).