title: A Fatal Case of Relapsing Pneumonia Caused by Legionella pneumophila in a Patient with Rheumatoid Arthritis After Two Injections of Adalimumab.
abstract: We present a rare fatal case of relapsing pneumonia caused by Legionella pneumophila in a patient with rheumatoid arthritis after only two injections of adalimumab. A 78-year-old Japanese woman with a 14-year history of rheumatoid arthritis was prescribed adalimumab because her disease activity remained high. However, 8 days after her second injection of adalimumab, she was admitted to our hospital and diagnosed with pneumonia caused by L. pneumophila. Following intravenous antibiotic therapy, she recovered completely from pneumonia and was discharged on day 10, but pneumonia relapsed, resulting in death 79 days after the first episode of pneumonia. L. pneumophila can lead to recurrence of pneumonia that can ultimately prove fatal, similar to the present case. A review of the pertinent literature is also presented.
authors.affiliation: Department of Orthopedics Surgery and Rheumatology, Nagano Red Cross Hospital, Wakasato, Nagano, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Hayashi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kuraishi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Masubuchi
authors.forename: Kaneyuki
authors.initials: K
authors.lastname: Furihata
authors.forename: Yuka
authors.initials: Y
authors.lastname: Aida
authors.forename: Tomonori
authors.initials: T
authors.lastname: Kobayakawa
authors.forename: Masao
authors.initials: M
authors.lastname: Deguchi
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Kojima
authors.forename: Naoki
authors.initials: N
authors.lastname: Ishiguro
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Kanamono
keywords: Legionella pneumophila; adalimumab; fatal infection; rheumatoid arthritis