prednylidene and Pneumonia--Pneumococcal

Tumor necrosis factor alpha (TNF-alpha) blocking drugs improve therapy for rheumatic diseases, but the risk of additional immunosuppression and infection is unclear. We report on a patient with rheumatoid arthritis treated with etanercept for 2 years, in addition to methotrexate and prednyliden, who developed fulminant pneumococcal pneumonia with rapid progression to fatal acute respiratory distress syndrome (ARDS) and septic shock. In patients receiving anti-TNF-alpha therapy, especially in combination with corticosteroids, signs of pulmonary infection should be regarded as very serious, as fulminant pneumonia with ARDS and severe sepsis may develop within 24 h.

Topics: Arthritis, Rheumatoid; Community-Acquired Infections; Drug Therapy, Combination; Etanercept; Fatal Outcome; Female; Glucocorticoids; Humans; Immunocompromised Host; Immunoglobulin G; Immunosuppressive Agents; Methotrexate; Middle Aged; Pneumonia, Pneumococcal; Prednisolone; Receptors, Tumor Necrosis Factor; Respiratory Distress Syndrome; Tumor Necrosis Factor-alpha