Pneumococcal meningitis and etanercept--chance or association?
Rheumatoid arthritis is a severe deforming chronic disease which has major implications for mortality and quality of life. Agents with anti-tumour necrosis factor alpha (TNFalpha) activity are a new modality of therapy, which can significantly reduce the acute inflammation in this condition. However, TNFalpha is a cytokine involved in initiating the protective immune response; consequently, patients receiving this therapy are at increased risk of infection. Etanercept is a recombinant form of the p75 TNF receptor (TNF-RII) dimerised by fusion with a portion of the human IgG1 Fc tail with anti-TNFalpha activity. We report the first case of a patient with rheumatoid arthritis who developed pneumococcal meningitis whilst on etanercept, suggesting a possible association between etanercept and this severe life threatening infection.
Killingley
B
B
Department of Infection and Tropical Medicine, Lister Unit, Northwick Park Hospital, Watford Road, London HA1 3UJ, UK. bkillingley@hotmail.com
Carpenter
V
V
Flanagan
K
K
Pasvol
G
G
D018501:Antirheumatic Agents / Q000009:adverse effects*; D002443:Ceftriaxone / Q000008:administration & dosage; D002939:Ciprofloxacin / Q000008:administration & dosage; D004198:Disease Susceptibility; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007262:Infusions, Intravenous; D008586:Meningitis, Pneumococcal / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology; D008875:Middle Aged; D010033:Otitis Media / Q000150:complications* / Q000175:diagnosis / Q000276:immunology / Q000382:microbiology; D018124:Receptors, Tumor Necrosis Factor; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000276:immunology / Q000302:isolation & purification*; D016896:Treatment Outcome
D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D002939:Ciprofloxacin; D002443:Ceftriaxone; D000068800:Etanercept