title: [A case of cavitating pneumococcal pneumonia developed during the treatment with etanercept for rheumatoid arthritis].
abstract: A 54-year-old woman who had been treated for rheumatoid arthritis (RA) with the anti-TNF-alpha drug, etanercept, was referred to our department on 27 April 2006 because of dyspnea and shock. Chest X-ray and computed tomography on admission indicated bilateral pneumonia which was proved to be caused by Streptococcus pneumoniae with positive blood culture results. The patient had recovered from multiple organ failure with intensive treatments such as NIPPV and cardiovascular support with cathecolamines, however, the left upper lobe of her lung had developed a large cavity that had been producing viable pneumococci on sputum culture for more than one month. As the development of lung necrosis and subsequent formation of a cavity is rare in patients with pneumococcal pneumonia, this case should be noted in terms of the relevance of both the fulminating pathogenecity of Streptococcus pneumoniae and the anti TNF-alpha drug treatment.
authors.affiliation: Department of Respiratory Medecine, Kobe City Medical Center General Hospital.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Kida
authors.forename: Yuka
authors.initials: Y
authors.lastname: Harada
authors.forename: Ryo
authors.initials: R
authors.lastname: Tachikawa
authors.forename: Akito
authors.initials: A
authors.lastname: Hata
authors.forename: Reiko
authors.initials: R
authors.lastname: Kaji
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Takeshima
authors.forename: Michio
authors.initials: M
authors.lastname: Hayashi
authors.forename: Takashi
authors.initials: T
authors.lastname: Nishimura
authors.forename: Keisuke
authors.initials: K
authors.lastname: Tomii
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Katakami
authors.forename: Kyosuke
authors.initials: K
authors.lastname: Ishihara
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D000068800:Etanercept; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011018:Pneumonia, Pneumococcal / Q000209:etiology*; D018124:Receptors, Tumor Necrosis Factor
chemical_list: D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept