Lethal acute respiratory distress syndrome during anti-TNF-alpha therapy for rheumatoid arthritis.
Tumor necrosis factor alpha (TNF-alpha) blocking drugs improve therapy for rheumatic diseases, but the risk of additional immunosuppression and infection is unclear. We report on a patient with rheumatoid arthritis treated with etanercept for 2 years, in addition to methotrexate and prednyliden, who developed fulminant pneumococcal pneumonia with rapid progression to fatal acute respiratory distress syndrome (ARDS) and septic shock. In patients receiving anti-TNF-alpha therapy, especially in combination with corticosteroids, signs of pulmonary infection should be regarded as very serious, as fulminant pneumonia with ARDS and severe sepsis may develop within 24 h.
Zimmer
Christian
C
Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Hufelandstrasse 55, 45122 Essen, Germany. christian.zimmer@uni-essen.de
Beiderlinden
Martin
M
Peters
Jürgen
J
D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D017714:Community-Acquired Infections; D004359:Drug Therapy, Combination; D000068800:Etanercept; D017809:Fatal Outcome; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects; D006801:Humans; D016867:Immunocompromised Host; D007074:Immunoglobulin G / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008727:Methotrexate / Q000009:adverse effects; D008875:Middle Aged; D011018:Pneumonia, Pneumococcal / Q000209:etiology* / Q000276:immunology / Q000473:pathology; D011239:Prednisolone / Q000009:adverse effects / Q000031:analogs & derivatives; D018124:Receptors, Tumor Necrosis Factor; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000276:immunology / Q000473:pathology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D005938:Glucocorticoids; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D011239:Prednisolone; C036266:prednylidene; D000068800:Etanercept; D008727:Methotrexate