Visceral leishmaniasis infection in a patient with rheumatoid arthritis treated with etanercept

Visceral leishmaniasis (VL) is a severe disease that can develop in immunocompromised patients. Antitumor necrosis factor-α (TNF-α) treatment of rheumatoid arthritis can result in clinical benefits, but with an increased risk of opportunistic infections. Leishmania infection in patients treated with TNF-α antagonists is extremely rare; for this reason, we report a patient with VL after etanercept treatment who had an unfavorable outcome.     

Recurrent allergic bronchopulmonary aspergillosis in a patient with rheumatoid arthritis treated with etanercept and tocilizumab

We report the case of a 68-year-old woman with Stage III and Class II rheumatoid arthritis (RA) that was resistant to prednisolone, methotrexate, and infliximab. After treatment with etanercept or tocilizumab, suspicious allergic bronchopulmonary aspergillosis (ABPA) repeatedly occurred and then rapidly improved after the withdrawal of each drug. We suspect that administration of etanercept and tocilizumab caused suspicious ABPA in this patient. The relevance to the pathogenesis of ABPA under these biological drugs is also discussed.     

Recurrent allergic bronchopulmonary aspergillosis in a patient with rheumatoid arthritis treated with etanercept and tocilizumab

Abstract

We report the case of a 68-year-old woman with Stage III and Class II rheumatoid arthritis (RA) that was resistant to prednisolone, methotrexate, and infliximab. After treatment with etanercept or tocilizumab, suspicious allergic bronchopulmonary aspergillosis (ABPA) repeatedly occurred and then rapidly improved after the withdrawal of each drug. We suspect that administration of etanercept and tocilizumab caused suspicious ABPA in this patient. The relevance to the pathogenesis of ABPA under these biological drugs is also discussed.     

Organizing pneumonia in a patient with rheumatoid arthritis treated with etanercept

Abstract

Etanercept-induced organizing pneumonia (OP) has not been reported in Japan. We describe the case of a rheumatoid arthritis patient who developed OP during etanercept treatment and discuss the possible mechanisms underlying the development of etanercept-induced OP and the existence of factors that predispose Japanese patients to drug-induced OP.     

Organizing pneumonia in a patient with rheumatoid arthritis treated with etanercept

Etanercept-induced organizing pneumonia (OP) has not been reported in Japan. We describe the case of a rheumatoid arthritis patient who developed OP during etanercept treatment and discuss the possible mechanisms underlying the development of etanercept-induced OP and the existence of factors that predispose Japanese patients to drug-induced OP.     

Use of etanercept in a patient with rheumatoid arthritis on hemodialysis

Disease-modifying anti-rheumatic drugs (DMARDs) are typically used for the therapy of rheumatoid arthritis (RA), but most have some nephrotoxicity. In several clinical studies, etanercept had fewer adverse effects on renal function than other DMARDs. We report the case of a 64-year-old woman with RA and renal insufficiency on hemodialysis treated using etanercept therapy. This case suggests that etanercept therapy might be effective in the short term for such patients.     

Monoarticular septic arthritis in a patient with juvenile rheumatoid arthritis under etanercept treatment

A 7-year-old girl with polyarticular type juvenile rheumatoid arthritis (JRA) presented with acute onset of right hip pain with limited range of motion and fever within the past two days. She had received etanercept for more than one year. Percutaneous arthrocentesis was performed and showed a white blood cell count of 84150/μL in the synovial fluid, although the culture showed negative results. The fever and right hip pain completely resolved after antibiotic treatment. Herein, we report the first case of septic monoarthritis of JRA under etanercept treatment.     

Use of etanercept in a patient with rheumatoid arthritis on hemodialysis

Abstract

Disease-modifying anti-rheumatic drugs (DMARDs) are typically used for the therapy of rheumatoid arthritis (RA), but most have some nephrotoxicity. In several clinical studies, etanercept had fewer adverse effects on renal function than other DMARDs. We report the case of a 64-year-old woman with RA and renal insufficiency on hemodialysis treated using etanercept therapy. This case suggests that etanercept therapy might be effective in the short term for such patients.     

Spinal infection by Mycobacterium xenopi in a non-immunosuppressed patient.

A previously fit 77-year-old woman was found to have a paravertebral abscess. This was aspirated, yielding Mycobacterium xenopi, but no other pathogens. Antituberculosis chemotherapy with four first-line agents was commenced, with some response but continuing pain. Reports of extrapulmonary M. xenopi infections are rare. Most previous cases have involved immunosuppressed patients. This is the first reported case of spinal M. xenopi infection in a non-immunosuppressed patient, but radiological evidence suggests that previous tuberculous infection may have damaged the lumbar vertebrae, rendering them susceptible to infection by M. xenopi.     

Legionella in a patient with rheumatoid arthritis receiving abatacept

Abatacept is a new drug available for refractory Rheumatoid Arthritis (RA), as other biologic therapies this drug is not free of potentially serious adverse events. We present a case of a 73 year-old patient treated with abatacept who suffered a Legionella pneumophila type 1 pneumoniae.     

Rapidly aggravated Mycobacterium avium infection in a patient with rheumatoid arthritis treated with infliximab

Infliximab was introduced along with methotrexate 8mg/week to a female patient with intractable rheumatoid arthritis. Although a dramatic improvement of her arthritic symptoms was achieved immediately, a small nodular shadow developed in the right middle field of her lung, visible on chest X-ray at the third injection. Because the nodular shadow rapidly increased its size in a week, transbronchial fiberoptic examination was performed and lavage fluid was obtained. The polymerase chain reaction was positive for Mycobacterium avium and the bacterial growth in culture confirmed the diagnosis. Although tuberculosis is a well-known adverse reaction to infliximab, development of nontuberculous mycobacteriosis is quite rare and no such report has so far been published in the context of infliximab usage. We should be alert to the fact that nontuberculous mycobacteriosis of slow progression in a usual clinical setting progresses quite rapidly, thus treatment should not be delayed, especially in patients on infliximab.     

Spinal infection with Mycobacterium xenopi

M. xenopi is well recognised as a pulmonary pathogen, but musculoskeletal infection is rare. Spinal infection is reported in a patient with systemic lupus erythematosus who was on corticosteroid therapy.     

Septic arthritis of the right ankle caused by Staphylococcus aureus infection in a rheumatoid arthritis patient treated with etanercept

Abstract

We report on a 65-year-old man with rheumatoid arthritis who developed septic arthritis of the right ankle and was treated with etanercept, low-dosage prednisolone, and salazosulfapyridine for 18 weeks. Staphylococcus aureus was cultured from ankle synovial fluid; hence, etanercept was stopped and cefazolin was administered. The patient responded well to arthroscopic synovectomy and irrigation of the ankle. Etanercept treatment should cease if it leads to septic arthritis and patients should be prescribed systemic antibiotics, with surgical debridement considered.