title: Fulminant legionellosis in two patients treated with infliximab for Crohn's disease: case series and literature review.
abstract: Two cases of fulminant pulmonary legionellosis, complicated by prolonged intensive care unit stays and acute respiratory distress syndrome, and who were recently treated with infliximab for Crohn's disease, are described. A review of the literature revealed three additional cases in patients with inflammatory bowel disease, and a total of 22 cases of Legionella pneumophila pneumonia in the context of treatment with antitumour necrosis (TNF)-alpha medications. The median age of the patients was 49 years, and men and women were affected equally. The case fatality rate was 14% (three of 22). Early recognition and treatment of this anti-TNF-alpha-related complication would likely result in reduced mortality and morbidity. Physicians prescribing anti-TNF-alpha drugs should be aware of this association.
authors.affiliation: Department of General Internal Medicine, McGill University Faculty of Medicine, Montreal, Quebec, Canada. adam.hofmann@mail.mcgill.ca
authors.forename: Adam
authors.initials: A
authors.lastname: Hofmann
authors.forename: Yanick
authors.initials: Y
authors.lastname: Beaulieu
authors.forename: Francis
authors.initials: F
authors.lastname: Bernard
authors.forename: Philippe
authors.initials: P
authors.lastname: Rico
mesh_terms: D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D003424:Crohn Disease / Q000188:drug therapy; D005260:Female; D006801:Humans; D000069285:Infliximab; D016952:Legionella pneumophila / Q000302:isolation & purification; D007877:Legionnaires' Disease / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000209:etiology / Q000401:mortality
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000069285:Infliximab