First-of-its-kind fellowship explores juncture of rheumatology, infectious disease
Leonard H. Calabrese, DO, chief medical editor of Healio Rheumatology and the director of the RJ Fasenmyer Center for Clinical Immunology at the Cleveland Clinic, has been practicing at the interface of rheumatology and infectious disease essentially for his entire career.
Calabrese was a pioneer in the early care of patients with HIV and continues to attend his weekly HIV clinic in the department of infectious diseases where he holds a secondary appointment. He also continues to engage in HIV-related research focusing primarily on immune-based therapies and understanding immunopathogenesis.
Calabrese told Healio Rheumatology that his work in the HIV field informed him of how logical the fusion of rheumatology and infectious diseases was, as many pathogens were well known to produce rheumatic diseases as well as serve as formidable comorbidities in managing patients receiving immunosuppressive therapies. In the biologic era, there also came the dimension of dealing with the new onslaught of serious and opportunistic infections, most of which he was well familiar with from his HIV experience.
Despite his long engagement in this field, Calabrese regretted never having formal training in infectious diseases and forthrightly expresses his gratitude to his ID colleagues who have educated and supported him so well over his career. In recent years, Calabrese has focused increasingly on understanding the epidemiology of chronic viral infections and rheumatic diseases including HIV, hepatitis C virus, John Cunningham virus, varicella zoster and more recently travel-related viral infections such as chikungunya and Zika.
Calabrese noted that about 7 or 8 years ago, he began to wonder who would take over this niche when he was no longer active in the field, though he adamantly insists he is not planning to go anywhere soon.
Fostering the Rheum-ID Connection
In 2014, he began discussions with Abby Abelson, MD, FACR, chair and fellowship program director of the department of rheumatology and immunologic disease at Cleveland Clinic, and Carlos Isada, MD, fellowship program director for the department of infectious diseases, about the possibility of developing an integrated fellowship program that would provide a trainee with the contact time and curriculum to achieve dual board eligibility. Abelson and Isada took up the challenge and, working with the specialty boards, crafted a demanding 36-month program that would achieve it.
At this time, there were only two remaining obstacles: No funds had been allocated for the new program and there were no immediate candidates ready to accept the opportunity and the challenge. Fortunately, procuring a candidate turned out to be the easiest part as Calabrese’s daughter, Cassandra, was serving a faculty year as chief resident in the Cleveland Clinic’s large internal medicine program and was extremely interested.
“I have long been interested in ID as my first research experience was working in the virology laboratory with Belinda Yen-Lieberman, PhD, a lifelong mentor, at the Clinic while I was still in high school,” Cassandra Calabrese, DO, told Healio Rheumatology. “Although that love for ID never left, at the same time, I was sold on a career in rheumatology.”
It was decided that the younger Calabrese would be the beta test subject of this fledgling program from 2015 to 2018. She has since graduated from the program, passed both sets of board examinations and remained on as faculty.
The second challenge was funding ,which was solved with a $500,000 matching grant from the RJ Fasenmyer Foundation, an organization that Leonard Calabrese has had a lifelong relationship with and who readily appreciated the forward-thinking concept. Currently, Calabrese is fund raising to build the endowment to allow a Rheum-ID fellow to be funded in perpetuity.
Setting the Standard
As the only program of its kind, it is attracting significant attention from institutions that would like to have such a faculty with this skill set as well as prospective applicants from around the world. Calabrese is confident that he will achieve the matching gift in the near future from one or more interested parties, but also seeks to expand the program if additional resources are attracted.
As for Cassandra Calabrese, she is already busy in her new role leading the Rheumatology-ID curriculum through which all rheumatology and ID fellows rotate. This curriculum emphasizes the intersection of rheumatology and infectious disease and is heavy on prevention and management of serious and opportunistic infections.
In addition, she has engaged in a variety of research projects in this new combined specialty, including examining the test characteristics of interferon gamma release assays screening for latent tuberculosis in immunocompromised hosts, the role of varicella zoster in stroke, and the connection between endocarditis and ANCA. She also serves as the point person in the center’s virtual clinic for immune-related adverse events from cancer immunotherapy.
“I love the mix of patients I get to see — ranging from chikungunya arthritis to complicated management decisions regarding serious infections in the setting of active rheumatic disease,” Cassandra Calabrese told Healio Rheumatology. “Being trained in both rheumatology and infectious disease has really helped me to appreciate the intersection of autoimmune, autoinflammatory and infectious diseases.”
She noted that she also enjoys having her HIV continuity clinic, as she has been amazed by what this disease has taught us about the immune system. As for the future, the Drs. Calabrese hope that there continue to be others who share their passion for this unique niche. – by Robert Stott
For more information:
- Leonard H. Calabrese, DO, can be reached at 9500 Euclid Ave. #A50, Cleveland, OH 44195; email: firstname.lastname@example.org.
- Cassandra Calabrese, DO, can be reached at 9500 Euclid Ave., Desk A50, Cleveland, OH 44195; email: email@example.com.
Disclosure: Cassandra Calabrese reports no relevant financial disclosures. Leonard Calabrese reports serving as an investigator and a consultant to Horizon Pharmaceuticals.