We present the case of a twenty six year-old woman with rheumatoid arthritis, treated with certolizumab. She sought medical attention due to cough, fever and night sweats. X-ray exam showed a miliary pneumonia. She was treated for tuberculosis and 50 days later she presented with aphasia. Magnetic nuclear resonance revealed brain lesions. Histoplasma capsulatum PCR test and urinary antigen were positive, so an antifungal treatment with voriconazole was started. Visual adverse effects forced to change the antifungal schedule in both the length of treatment and the antifungal drug. With this measure the patient progressed favorably. The test of urinary Histoplasma capsulatum antigen and PCR amplification were key to make a diagnosis and also for a follow-up.

我们介绍了一位患有类风湿性关节炎的 26 岁女性接受赛妥珠单抗治疗的病例。她因咳嗽、发烧和盗汗而寻求医疗救助。 X 光检查显示粟粒性肺炎。她接受了肺结核治疗，50 天后出现失语症。核磁共振显示脑部病变。荚膜组织胞浆菌PCR检测和尿抗原呈阳性，因此开始伏立康唑抗真菌治疗。视觉不良反应迫使我们改变治疗时间和抗真菌药物的抗真菌治疗方案。通过这一措施，患者的病情进展顺利。尿荚膜组织胞浆菌抗原检测和PCR扩增是诊断和随访的关键。