Infliximab and brucellosis: not the usual suspects, this time

Abstract

Tumor necrosis factor (TNF) plays an important role in the host defense mechanism, and anti-TNF antibody therapies may increase the risk of serious infections. We herein report a case of 57-year-old male with rheumatoid arthritis who developed brucellosis during treatment with infliximab in combination with methotrexate and a low-dose steroid. Brucellosis should be kept in mind, particularly in endemic areas, in patients receiving anti-TNF therapy. Clinicians should be aware of brucellosis symptoms and ways of contamination and should warn their patients. Early diagnosis and rapid treatment may prevent a possible poor course of the disease in immunocompromised patients.

The Reported Adverse Effects Related to Biological Agents Used for the Treatment of Rheumatic Diseases in Turkey

“…We identified three patients in Turkey with infections related to adverse events who were treated with infliximab and one who was treated with adalimumab. [27][28][29][30] …”

Brucellosis in Immunocompromised Hosts

“…Early institution of appropriate antimicrobial therapy is essential to control Brucella infection and to prevent complication [172,173].…”

“…Unfortunately, the diagnosis or recognition of infections in patients with rheumatic diseases may be difficult and delayed due to the following reasons: (1) the clinical manifestations of certain infections such as brucellosis may be indistinguishable from those of the underlying disease, and (2) the typical signs and symptoms of these infectious complications may be atypical or entirely absent [185]. Patients with rheumatic disorders are susceptible to infections with various micro-organisms, particularly bacteria and opportunistic agents due to the following factors: (1) the underlying rheumatic disorders, and (2) the administered immunosuppressive agents such as: corticosteroids, azathioprine, cyclophosphamide, anti-TNF therapy such as infliximab and targeted therapies such as rituximab [173,[185][186][187].…”

“…TNF plays an important role in the host defense mechanisms and anti-TNF therapies may increase the risk of infections in patients with rheumatic diseases [173]. Brucellosis should be kept in mind, particularly in endemic areas, in patients receiving anti-TNF therapies as brucellosis has been reported in patients with RA receiving infliximab [173,186,187].…”

“…Brucellosis should be kept in mind, particularly in endemic areas, in patients receiving anti-TNF therapies as brucellosis has been reported in patients with RA receiving infliximab [173,186,187]. In patients with RA, infection is a major comorbidity and is related to the immunosuppressive therapies given and to the intrinsic effects of RA on certain body organs specifically the musculoskeletal system, while in patients with systemic lupus erythromatosis, infection is a cause of hospital admission and is a leading complication following admission [185].…”