Abstract
Patients with long-standing, severe, erosive rheumatoid arthritis who have extra-articular manifestations and have undergone joint replacement surgery are at increased risk for serious infection and premature mortality. New therapies, including cytokine antagonists, hold great promise for improving the course of rheumatoid arthritis. However, they have powerful anti-inflammatory effects that may mask symptoms of serious infection. We report a case of fatal pneumococcal sepsis occurring in a 37-year-old woman with rheumatoid arthritis treated with the tumor necrosis factor antagonist etanercept and suggest management strategies for early detection and management of this complication.
MeSH terms
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Adult
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Anti-Inflammatory Agents / therapeutic use
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Antirheumatic Agents / adverse effects*
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Arthritis, Infectious / chemically induced*
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Arthritis, Infectious / diagnosis
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Arthritis, Infectious / drug therapy
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Arthritis, Rheumatoid / drug therapy*
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Arthritis, Rheumatoid / immunology
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Arthritis, Rheumatoid / surgery
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Bacteremia / chemically induced*
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Bacteremia / diagnosis
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Bacteremia / drug therapy
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Drug Therapy, Combination
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Etanercept
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Fasciitis, Necrotizing / chemically induced*
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Fasciitis, Necrotizing / diagnosis
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Fasciitis, Necrotizing / drug therapy
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Fatal Outcome
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Female
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Humans
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Immunoglobulin G / adverse effects*
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Pneumococcal Infections / chemically induced*
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Pneumococcal Infections / diagnosis
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Pneumococcal Infections / drug therapy
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Prednisone / therapeutic use
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Receptors, Tumor Necrosis Factor
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Severity of Illness Index
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Streptococcus pneumoniae*
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Tumor Necrosis Factor-alpha / antagonists & inhibitors*
Substances
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Anti-Inflammatory Agents
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Antirheumatic Agents
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Immunoglobulin G
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Receptors, Tumor Necrosis Factor
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Tumor Necrosis Factor-alpha
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Etanercept
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Prednisone