title: Fatal complication of Legionella pneumophila pneumonia in a tocilizumab-treated rheumatoid arthritis patient.
abstract: We herein report a fatal case of Legionella pneumophila pneumonia in a tocilizumab-treated rheumatoid arthritis patient who was in a state of shock on admission but remained afebrile even during severe pneumonia. Legionella antigen was detected in the urine and neutrophil CD64 expression was highly elevated. Despite undergoing intensive treatment, the patient developed sepsis and died 12 days after admission. An autopsy indicated that while the Legionella infection had almost been controlled, a subarachnoid hemorrhage was the ultimate cause of death.
authors.affiliation: Department of Rheumatology, National Hospital Organization Sagamihara National Hospital, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Arinuma
authors.forename: Shinichi
authors.initials: S
authors.lastname: Nogi
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ishikawa
authors.forename: Hisanori
authors.initials: H
authors.lastname: Nakayama
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hashimoto
authors.forename: Akiko
authors.initials: A
authors.lastname: Komiya
authors.forename: Kenji
authors.initials: K
authors.lastname: Minoguchi
authors.forename: Ayako
authors.initials: A
authors.lastname: Horita
authors.forename: Ikuo
authors.initials: I
authors.lastname: Saito
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Matsui
authors.forename: Shigeto
authors.initials: S
authors.lastname: Tohma
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D018501:Antirheumatic Agents / Q000008:administration & dosage*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy / Q000276:immunology; D017809:Fatal Outcome; D006760:Hospitalization; D006801:Humans; D016867:Immunocompromised Host; D016952:Legionella pneumophila / Q000302:isolation & purification*; D007877:Legionnaires' Disease / Q000209:etiology / Q000276:immunology* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D018805:Sepsis / Q000150:complications / Q000276:immunology* / Q000382:microbiology; D013345:Subarachnoid Hemorrhage / Q000382:microbiology*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; C502936:tocilizumab