title: Acute pneumonitis in a patient with adult-onset disease after toclizumab treatment with good response to anakinra.
abstract: Pulmonary involvement in the form of acute pneumonitis in adult-onset Still's disease (AOSD) is an uncommon manifestation, with few cases reported in the literature. We report the case of a 61-year-old male with 3 years of AOSD evolution, treated with methotrexate (MTX) and half-dose corticosteroids, which debuted with symptoms of fever, dyspnea and dry cough after 3 weeks of receiving the first dose of tocilizumab (TCZ). In the follow-up study showed leukocytosis with left shift, elevated serum ferritin and C-reactive protein standard. The chest CT scan showed ground-glass pattern predominantly in central and upper lobes and the BAL shows an increase in the percentage of lymphocyte with normal subpopulations and negative cultures. MTX and TCM were suspended, prednisone was increased to 30mg/day and within a week Anakinra 100mg/day SC was iniciated, noting in a few days a progressive clinical, analytical and radiological improvement.
authors.affiliation: Servicio de Reumatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España. Electronic address: clararwen@hotmail.com.
authors.forename: Clara
authors.initials: C
authors.lastname: Sangüesa Gómez
authors.affiliation: Servicio de Reumatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España.
authors.forename: Bryan Josué
authors.initials: BJ
authors.lastname: Flores Robles
authors.affiliation: Servicio de Neumología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Jara Chinarro
authors.affiliation: Servicio de Reumatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España.
authors.forename: María
authors.initials: M
authors.lastname: Espinosa Malpartida
authors.affiliation: Servicio de Reumatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España.
authors.forename: Carmen
authors.initials: C
authors.lastname: Barbadillo Mateos
mesh_terms: D000208:Acute Disease; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D053590:Interleukin 1 Receptor Antagonist Protein / Q000627:therapeutic use*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis / Q000209:etiology*; D011241:Prednisone / Q000627:therapeutic use; D016706:Still's Disease, Adult-Onset / Q000150:complications / Q000188:drug therapy*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D053590:Interleukin 1 Receptor Antagonist Protein; C502936:tocilizumab; D011241:Prednisone; D008727:Methotrexate
keywords: Acute neumonitis; Adult-onset Still's disease; Enfermedad de Still del adulto; Methotrexate; Metotrexato; Neumonitis aguda; Tocilizumab