Purulent pericarditis in a patient with rheumatoid arthritis treated with etanercept and methotrexate.
Purulent pericarditis is rarely seen in this post-antibiotic era. We report a case of spontaneous purulent pericarditis in a patient with rheumatoid arthritis being treated with etanercept, a tumour necrosis factor-alpha (TNF-alpha) antagonist, and methotrexate, an immunosuppressant. Both are disease-modifying anti-rheumatic drugs. We discuss the pathophysiology of purulent pericarditis and the recent literature on the infectious complications of TNF-alpha antagonists.
Sweet
David D
DD
Emergency Medicine and Critical Care Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Isac
George
G
Morrison
Bruce
B
Fenwick
John
J
Dhingra
Vinay
V
D000368:Aged; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects*; D010493:Pericarditis / Q000382:microbiology*; D018124:Receptors, Tumor Necrosis Factor / Q000008:administration & dosage; D013203:Staphylococcal Infections / Q000175:diagnosis; D013211:Staphylococcus aureus / Q000302:isolation & purification; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000068800:Etanercept; D008727:Methotrexate