683: Necrotizing Fasciitis and Candidemia After Tocilizumab Initiation: A Case Report
| Autor: | Desiree Kosmisky, Erika Setliff, Ramiel Ngeve |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
education.field_of_study Tofacitinib business.industry Septic shock Population Critical Care and Intensive Care Medicine medicine.disease Golimumab chemistry.chemical_compound Tocilizumab chemistry Cellulitis Internal medicine Medicine Medical history business education Fasciitis medicine.drug |
| Zdroj: | Critical Care Medicine. 49:336-336 |
| ISSN: | 0090-3493 |
| DOI: | 10.1097/01.ccm.0000728620.08082.ed |
| Popis: | INTRODUCTION: Tocilizumab (TCZ) is an interleukin-6 receptor antagonist approved for the treatment of moderate to severe active rheumatoid arthritis (RA) in patients with inadequate response to one or more disease-modifying anti-rheumatic drugs It carries a boxed warning for serious infections Here we describe a case in which a patient experienced both community and hospital-acquired infections (HAI) with multiple pathogens after TCZ receipt METHODS: A septuagenarian female with an extensive medical history presented to the emergency department with cellulitis and leg swelling 3 days after receiving the first outpatient dose of 380 mg IV TCZ for RA after failing therapy with golimumab, abatacept, and tofacitinib At the time of the first infusion, an eraser-sized wound was noted on her leg The patient reported that it had been scratched a week prior She rapidly developed septic shock with necrotizing fasciitis that necessitated an emergent above-the-knee amputation The wound culture and initial blood cultures grew Serratia marcescens A central line was placed for vasopressor administration and she was treated in the ICU for septic shock and acute kidney injury On hospital days 3 and 4, the patient remained febrile and blood cultures grew Candida albicans, which was deemed a central line-associated blood stream infection The patient died on hospital day 6 from complications related to her infections RESULTS: These observed events in our patient highlight important findings regarding therapy with TCZ There exist previous case reports linking TCZ with development of similar skin and soft tissue infections Many of these reports raise the concern that TCZ treatment may mask or delay symptoms and laboratory markers of severe life-threatening infections, leading to delays in presentation and treatment With the use of TCZ in some hospitalized patients with COVID-19 infection, additional reports have described development of candidemia following TCZ administration This patient rapidly experienced two serious infections shortly after initiation of TCZ therapy, highlighting the need for close patient monitoring and vigorous infection control measures in this population Further study is warranted to better describe the potential relationship between TCZ and risk for HAI |
| Databáze: | OpenAIRE |
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