For what fungal infections might patients on biologic therapies be at risk?

Patients on TNF-a agonists most commonly are at risk for histoplasmosis, candidiasis, and aspergillosis. There may be a different degree of risk with each of the agents—infliximab creating a higher risk than etanercept or adalimumab. In endemic areas, patients are also at risk for primary or reactivation of latent coccidioidomycosis. One recent series reported 13 cases of coccidiomycosis, with two patients dying of disseminated disease. Close monitoring of current and past residents of endemic areas in the form of baseline and serial chest x-ray and serology is indicated.

Tsiodras S, Samonis G, Boumpas DT, Kontoyiannis DP: Fungal infections complicating tumor necrosis factor alpha blockade therapy, Mayo Clin Proc 83(2):181–194, 2008.