Pseudomonas meningoencephalitis masquerading as a stroke in a patient on tocilizumab

Williams, Cameron; Foote, Andrew P; Choi, Philip

doi:10.1136/bcr-2018-227296

Cited by 4 publications

(3 citation statements)

References 5 publications

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“…Our literature search in PubMed using “tocilizumab” with special attention to cases of infectious diseases during TCZ therapy and reported CRP levels at the time of diagnosis yielded a total of 28 case reports on this specific issue ( Table 2 ) [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ]. In 15 out of 28 reported cases, CRP was normal or only slightly elevated.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Tocilizumab on Inflammatory Markers in Patients Hospitalized with Serious Infections. Case Series and Review of Literature

Berman

Ben‐Ami

Berliner

et al. 2021

Life

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Background: The human anti-IL-6 receptor antibody tocilizumab (TCZ) has been approved for the treatment of rheumatoid arthritis (RA) and giant cell arteritis (GCA). It is observed that CRP levels drop quickly after starting TCZ treatment. This may lead to misinterpretation of laboratory results when accessing the patient with infectious disease while on TCZ. We conducted this study to report cases treated with tocilizumab who developed serious infections with special reference to levels of CRP and to review the literature on the effect of tocilizumab on acute phase response (APR) during infections. Methods: The files of RA and GCA patients hospitalized in the Tel Aviv medical center between 2009–2019 were reviewed. Cases of patients with RA and GCA treated with tocilizumab who were hospitalized due to severe infections were reviewed with special emphasis on the duration of treatment, type of infection, and APR. Results: We identified nine admissions. Seven patients were treated with tocilizumab for RA, two for GCA. The diagnosis was pneumonia in three cases, osteomyelitis in one, cellulitis in one, endocarditis due to Whipple disease in one, abscess of cervix uteri in one, meningitis in one, and perforated diverticulitis in one. The mean CRP levels on admission were 4.75 mg/L (normal range, up to 5 mg/L). All cases were diagnosed correctly on admission. Conclusions: CRP levels may not correctly reflect the severity of infectious diseases during tocilizumab treatment. Increased awareness of the masking effect of tocilizumab on the APR during infection is needed in order to avoid a delay in the diagnosis.

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Section: Discussionmentioning

confidence: 99%

The Effect of Tocilizumab on Inflammatory Markers in Patients Hospitalized with Serious Infections. Case Series and Review of Literature

Berman

Ben‐Ami

Berliner

et al. 2021

Life

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“…But personal history, parasitic serology, MRI, and antiparasitic treatment can be helpful in differentiation [53]. In addition, Streptococcal pneumoniae meningitis secondary to acute mastoiditis, Escherichia coli meningitis, and Pseudomonas meningoencephalitis had also been reported mimicking stroke in the previous literatures [54][55][56]. COVID-19 infection may present as a stroke, also it can mimic a stroke even there is no respiratory syndrome at all [57][58][59][60].…”

Section: Infectionsmentioning

confidence: 99%

Stroke mimics: A review

Wang

2023

J Clin Images Med Case Rep

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“…This may be related to the fewer cases of AE treated with tocilizumab. For example, in treating a patient with rheumatoid arthritis and another patient with juvenile idiopathic arthritis, meningoencephalitis was induced ( 57 ); in treating a patient with refractory giant cell arteritis, tocilizumab was considered to be a possible cause of Pseudomonas meningitis ( 58 ). Patients with rheumatoid arthritis who were given tocilizumab also had cognitive impairment and leukoencephalopathy ( 59 ).…”

Section: Tocilizumabmentioning

confidence: 99%

Immunotherapy for Refractory Autoimmune Encephalitis

Yang

Liu

2021

Front. Immunol.

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Autoimmune encephalitis (AE) is an immune-mediated disease involving the central nervous system, usually caused by antigen-antibody reactions. With the advent of autoantibody-associated diseases, AE has become a hot research frontier in neuroimmunology. The first-line conventional treatments of autoimmune encephalitis consist of steroids, intravenous immunoglobulin (IVIG), plasma exchange (PLEX), and second-line therapy includes rituximab. Despite considerable research and expanding clinical experience, current treatments are still ineffective for a significant number of patients. Although there is no clear consensus, clinical trial evidence limited, and the level of evidence for some of the drugs based on single reports, third-line therapy is a viable alternative for refractory encephalitis patients. With the current rapid research progress, a breakthrough in the treatment of AE is critical. This article aims to review the third-line therapy for refractory AE

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Pseudomonas meningoencephalitis masquerading as a stroke in a patient on tocilizumab

Cited by 4 publications

References 5 publications

The Effect of Tocilizumab on Inflammatory Markers in Patients Hospitalized with Serious Infections. Case Series and Review of Literature

The Effect of Tocilizumab on Inflammatory Markers in Patients Hospitalized with Serious Infections. Case Series and Review of Literature

Stroke mimics: A review

Immunotherapy for Refractory Autoimmune Encephalitis

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