Mycobacterial hand infections occurring postoperatively in patients treated with tumor necrosis factor-alpha inhibitors for inflammatory arthritis: report of three cases.
Tumor necrosis factor-alpha inhibitors are potent anti-rheumatic drugs, but there is evidence that the high level of immunosuppression they provide may also lead to a higher risk of infections. At our institution, 3 patients with inflammatory arthritis treated with tumor necrosis factor-alpha inhibitors developed mycobacterial soft tissue infections after routine hand surgery. All 3 patients required multiple surgical procedures, inpatient hospitalizations, and prolonged antibiotic multidrug therapy to clear the infections.
Bauer
Andrea S
AS
Division of Hand Surgery, Department of Orthopedics, Brigham and Women's Hospital, Boston, MA 02115, USA.
Blazar
Philip E
PE
Earp
Brandon E
BE
Simmons
Barry P
BP
D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D015535:Arthritis, Psoriatic / Q000188:drug therapy*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D017963:Azithromycin / Q000627:therapeutic use*; D000068800:Etanercept; D005260:Female; D006225:Hand / Q000601:surgery*; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D000069285:Infliximab; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D009164:Mycobacterium Infections / Q000175:diagnosis* / Q000188:drug therapy; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D013717:Tenosynovitis / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D017963:Azithromycin; D000069285:Infliximab; D000068800:Etanercept; D008727:Methotrexate