Invasive fungal diseases in patients with rheumatic diseases

Invasive fungal diseases (IFDs), especially pneumocystosis, cryptococcosis, histoplasmosis, and coccidioidomycosis, are increasingly observed among patients with systemic autoimmune diseases. Such patients are susceptible to the abovementioned IFDs because of their disease-related immunological defects and/or concomitant immunosuppressive therapies. The knowledge of the epidemiology of endemic and nonendemic mycoses such as the risk factors for IFDs is crucial for the patient's assessment. A high index of suspicion is mandatory because the diagnosis is often challenging due to potential overlap between the signs and symptoms of the underlying autoimmune disease and the IFD clinical presentation. After appropriate microbiological sample collection, a prompt antifungal treatment is mandatory due to the high mortality of IFDs in immunocompromised patients without appropriate therapy.