Pulmonary infectious complications associated with anti-TNFalpha therapy (infliximab) for rheumatoid arthritis.
Two patients with rheumatoid arthritis (RA) that developed serious infectious complications following anti-TNFalpha therapy (infliximab) are reported. Patient 1 developed tuberculosis with high fever, refractory diarrhea and mediastinal lymphadenopathy. Trans-bronchial needle biopsy was useful to confirm the diagnosis. Patient 2 showed sudden onset of dyspnea with diffuse bilateral lung infiltration caused by pneumocystis jiroveci pneumonia and the diagnosis was confirmed by broncho-alveolar lavage. Physicians should be alerted to infectious complications with atypical presentation and rapid progression in infliximab-treated patients. Invasive diagnostic procedures including fiber-optic bronchoscopy may be necessary early in the course for such cases.
Imaizumi
Kazuyoshi
K
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine.
Sugishita
Mihoko
M
Usui
Miho
M
Kawabe
Tsutomu
T
Hashimoto
Naozumi
N
Hasegawa
Yoshinori
Y
D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D000069285:Infliximab; D008727:Methotrexate / Q000009:adverse effects; D009894:Opportunistic Infections; D045363:Pneumocystis carinii; D011020:Pneumonia, Pneumocystis / Q000209:etiology*; D014397:Tuberculosis, Pulmonary / Q000209:etiology*; D014409:Tumor Necrosis Factor-alpha
D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D008727:Methotrexate