In this context, with the purpose of preventing fungal infections while anti-TNFα therapy, considerations for screening and prevention must include anti-TNFα therapy risk of fungal infection, close followup during the first 3 months, suspicion of fungal infection when fever is presented, and avoiding high-risk exposures (cave exploring and bird roosts) and patients from Coccidioides endemic areas should have titers checked prior to initiation of anti-TNF therapy [2]. Here, TNF is linked to fungal infectious disease.