title: An inconspicuous insect bite as the cause of sepsis in a patient treated with infliximab due to rheumatoid arthritis.
abstract: The monoclonal antibody against TNFa (infliximab) suppresses cytokines involved in inflammatory reaction. Consequently, infliximab is a potent agent in treating refractory rheumatoid arthritis (RA). There is also evidence showing beneficial anti-TNFα therapy effect on RA-related amyloidosis AA. TNFα inhibition may, however, lead to leucopenia and, eventually, severe sepsis. We discuss a case of RA with RA-related AA amyloidosis and renal impairment which was refractory to disease-modifying anti-rheumatic drug (DMARD). The treatment led to inflammatory complications of two distinct phases: immediately after drug administration and six weeks later. Both phases were linked to an innocuous skin infection.
authors: Department of Nephrology and Transplantation Medicine, Wrocław Medical University, Wroclaw, Poland. malgorzata.litwin@gmail.com
authors: M
authors: M
authors: Zynek-Litwin
authors: J
authors: J
authors: Kuźniar
authors: B
authors: B
authors: Noceń-Rychlewska
authors: M
authors: M
authors: Kusztal
authors: M
authors: M
authors: Klinger
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000069285:Infliximab; D007299:Insect Bites and Stings / Q000150:complications / Q000276:immunology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D018805:Sepsis / Q000150:complications / Q000209:etiology* / Q000276:immunology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D000069285:Infliximab