Powerful immunosuppressant agents predispose patients to fungal infections

Patients on powerful immunocompromising agents might be predisposed to infections, including fungal infections, according to Whitney High, M.D., M.Eng., professor of dermatology and director of the Dermatology Clinic and Dermatopathology Laboratory at University of Colorado Anschutz Medical Campus in Aurora, Colo.

“We’ve seen a lot of new fungal infections, particularly in patients that are on some of the new biologic agents like rituximab-a powerful anti-CD20 antibody,” says Dr. High, who presented on odd and unusual skin infections during the European Academy of Dermatology and Venereology (EADV)/American Academy of Dermatology (AAD) Joint Symposium session at the AAD Summer Meeting in July.

Patients with compromised immune systems are becoming a larger portion of the population with the advent of drugs like rituximab, which the FDA recently approved for treatment of pemphigus, an autoimmune bullous condition.

“There are even some infections associated with diabetes, which people don’t always immediately recognize as an immunocompromising condition, like necrotizing fasciitis,” Dr. High says. “It’s important to be aware that something as ubiquitous as diabetes could be a predisposing condition for infection.”

Dr. High presented a case of a patient who was on rituximab who presented with an unusual fungal infection caused by Mucor, a rare fungal organism that chiefly affects people with diabetic ketoacidosis.

“The diagnosis was delayed because people weren’t really considering the totality of circumstances and the fact that this patient was on rituximab,” he says. “Tissue cultures weren’t delayed because the patient wasn’t a diabetic and was not in diabetic ketoacidosis, but he was on a very powerful immunosuppressive drug."

Newer highly immunosuppressive biologic agents don’t have long-term data.

“Many of these medicines have been out years, instead of decades, and so we’re still learning about where the dangers lie,” he says.

The potential association between some biologic agents and the increased risk for fungal infections isn’t necessarily universal among all biologic therapies, according to Dr. High.

“Not all biologics are equal. Biologics we use for atopic dermatitis, like dupilumab, are different than the biologic we use for pemphigus. Dupilumab is probably not as powerful in its immunosuppressive properties,” he says.

Disclosures:

Dr. High reports no relevant disclosures.