강직성척추염에 대한 주된 약물 치료로 종양괴사인자억 제제의 사용이 증가하면서 좋은 치료 효과를 보이고 있으나 이와 함께 기회 감염의 발생 가능성도 증가하고 있다. 진균 감염은 결핵과는 달리 예방적 치료가 불가능하고 무증상 감염이 많다는 문제점을 가지고 있다. 저자들은 강직성척추염 환자에서 etanercept 사용 후 폐 크립토코쿠스증이 발생하여 항진균제로 치료한 증례를 국내에서 처음으로 경험하였기에 문헌 고찰과 함께 보고하는 바이다.
Ankylosing spondylitis (AS) is a chronic inflammatory disorder, commonly characterized by inflammation of axial skeleton and development of enthesopathies. Tumor necrosis factor inhibitors (TNFi) shows good therapeutic responses in AS patients without good response to non-steroidal anti-inflammatory drugs. Although TNFi are relatively safe for AS patients, serious opportunistic infections, including tuberculosis and fungal infection, could develop. Here, according to our knowledge, we report a first Korean case of pulmonary cryptococcosis in a patient with AS treated with etanercept. A 64 year-old man with AS visited due to a newly appeared pulmonary nodule on a routine chest radiography. He had been administered etanercept for 5 months. Histologic findings of the lung nodule showed characteristic features of cryptococcosis. Etanercept was discontinued and oral fluconazole was administrated, as there was no evidence of central nervous system involvement. After 7 months of treatment, chest CT showed an improvement of the pulmonary lesion.