Cough and fever in a female with Crohn's disease receiving infliximab

Stratakos, Grigoris; Kalomenidis, I.; Papas, V; Malagari, K.; Kollintza, Androniki; Roussos, Ch.; Anagnostopoulou, Maria; Paniara, Olga; Zakynthinos, Spyros; Papiris, Spyridon

doi:10.1183/09031936.05.00005205

Cited by 21 publications

(18 citation statements)

References 12 publications

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“…2018;9(2):68-72 therapy. As reviewed, there are 10 cases described in literature, all under anti-TNF therapy [22][23][24][25][26][27][28][29][30][31]. To our knowledge, this is the first described case of nocardiosis in a patient under TCZ.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Nocardiosis in a Patient With Rheumatoid Arthritis Under Treatment With Tocilizumab

et al. 2018

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The use of biological therapy has revolutionized the treatment of various autoimmune diseases. Tocilizumab (TCZ) is a recombinant humanized antiinterleukin-6 (IL-6) receptor monoclonal antibody approved for the treatment of patients with rheumatoid arthritis, as monotherapy or in combination with other disease-modifying antirheumatic drugs (DMARDs). Clinical and post-marketing surveillance studies of TCZ indicate that infections are the most frequent adverse events. Most of the serious infections described are bacterial and viral, with no uncommon pathogens. The authors report a case of a patient with destructive rheumatoid arthritis under TCZ that presented with neurological symptoms and a right cerebellar lesion with marked diffusion restriction suggestive of cerebellar abscess. The microbiologic studies from aspirative cerebral biopsy revealed Nocardia farcinica. With adequate antibiotics, the patient evolved with resolution of all symptoms and brain abscess at 5 months of followup. According to published reports, this is the first case of nocardial infection in patients under TCZ. The case highlights the importance of being aware of risk infection in these patients and need of an early diagnosis allowing a prompt treatment.

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Section: Discussionmentioning

confidence: 99%

Cerebral Nocardiosis in a Patient With Rheumatoid Arthritis Under Treatment With Tocilizumab

et al. 2018

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“…12 Chest radiograph and CT scan revealed multiple lung nodules. Bronchoalveolar lavage fluid revealed N asteroides and Pneumocystis jiroveci.…”

Section: Casementioning

confidence: 97%

“…[16][17][18] Combination therapy of 2 or more agents may be warranted in severe systemic or CNS infections. 19,20 Systemic infection (lungs, skin and brain) 75-year-old man (RA) 9 Adalimumab Corticosteroids Lungs 70-year-old man (RA) 6 Infliximab Methotrexate, corticosteroids Skin 53-year-old woman (Crohn's disease) 10 Infliximab Mesalamine, azathioprine, corticosteroids Lungs 66-year-old woman (psoriasis) 4 Infliximab Alefacept Adrenal glands 45-year-old man (Crohn's disease) 11 Infliximab Budesonide, mesalamine, prednisone Skin 77-year-old woman (Crohn's disease) 12 Infliximab Methylprednisolone, azathioprine Lungs a References are indicated by superscript numbers after the case description. RA, rheumatoid arthritis; TMP-SMZ, trimethoprim-sulfamethoxazole.…”

Section: Casementioning

confidence: 99%

Risk of Nocardial Infections With Anti-tumor Necrosis Factor Therapy

Ali

Chakraburtty

Mahmood

et al. 2013

The American Journal of the Medical Sciences

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“…PCP has been reported in IBD patients on various medication regimens including cyclosporine, tacrolimus, infliximab, adalimumab, and azathioprine [3,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]. In one cohort study, patients with IBD were found to have significantly increased risk of PCP compared to the general population with an adjusted hazards ratio of 2.96 [4].…”

Section: Increased Risk Of Pcp In Inflammatory Bowel Diseasementioning

confidence: 99%

Pneumocystis Pneumonia in Inflammatory Bowel Disease: The Costs of Immunosuppression

DeFilippis¹,

Scherl²

2015

J Gastrointest Dig Syst

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Patients with inflammatory bowel disease (IBD) are subject to a spectrum of immunosuppressive agents including corticosteroids, immunomodulators, and biological therapies. Despite the benefits of these therapies and their ability to induce remission, they increase the risk of infectious complications with various organisms including Pneumocystis jiroveci pneumonia (PCP), which is associated with significant morbidity and mortality. Although PCP infection is typically associated with HIV-infected populations, the risk is increased in patients with IBD. Inflammatory autoimmune diseases like IBD account for as high as 20% of PCP infection in HIV-negative patients with greater than 50% mortality. Despite this, there are no clear guidelines for PCP prophylaxis in IBD. PCP should be considered in the differential when an IBD patient on immunosuppression presents with fever and respiratory symptoms. Here we review the existing literature regarding PCP risk in inflammatory bowel disease, the role of tumor necrosis alpha-inhibitors, and considerations for prophylaxis.

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Cough and fever in a female with Crohn's disease receiving infliximab

Cited by 21 publications

References 12 publications

Cerebral Nocardiosis in a Patient With Rheumatoid Arthritis Under Treatment With Tocilizumab

Cerebral Nocardiosis in a Patient With Rheumatoid Arthritis Under Treatment With Tocilizumab

Risk of Nocardial Infections With Anti-tumor Necrosis Factor Therapy

Pneumocystis Pneumonia in Inflammatory Bowel Disease: The Costs of Immunosuppression

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