Dederichs F, Pinciu F, Gerhard H, Eveld K, Stallmach A
Abteilung für Gastroenterologie, Hepatologie und Infektologie, Universitätsklinikum Jena, Germany.
Z Gastroenterol. 2006 Aug;44(8):657-60. doi: 10.1055/s-2006-926670.
A 42-year-old man with steroid-dependent Crohn's disease developed fever, vomiting and headache after the second administration of infliximab. Extensive microbiological and biochemical work-up revealed an atypical meningitis caused by Listeria monocytogenes. After antibiotic therapy of 21 days duration, the patient could be discharged from hospital totally recovered without any further complications. As previously demonstrated, TNF-alpha plays an important role in resistance to Listeria monocytogenes. Listeria infections have been reported in 26 patients receiving TNF-alpha inhibitors. An additional therapy with other immunosuppressants increases the risk for Listeria infections. Listeria meningitis is a seldom adverse event of therapy with TNF-alpha inhibitors but is associated with a high lethality. Therefore patients should be informed about the possible adverse event of a Listeria infection during anti-TNF-alpha therapy before receiving immunosuppressive treatment. Furthermore, therapy with TNF-alpha inhibitors should only be executed within a close doctor-patient relationship and in cooperation with specialised centres.
一名42岁的依赖类固醇的克罗恩病男性患者在第二次注射英夫利昔单抗后出现发热、呕吐和头痛。广泛的微生物学和生化检查显示为单核细胞增生李斯特菌引起的非典型脑膜炎。经过为期21天的抗生素治疗，患者康复出院，未出现任何进一步的并发症。如先前所示，肿瘤坏死因子-α在抵抗单核细胞增生李斯特菌方面发挥重要作用。已有26例接受肿瘤坏死因子-α抑制剂治疗的患者报告感染李斯特菌。同时使用其他免疫抑制剂会增加感染李斯特菌的风险。李斯特菌脑膜炎是肿瘤坏死因子-α抑制剂治疗罕见的不良事件，但致死率很高。因此，在接受免疫抑制治疗前，应告知患者抗肿瘤坏死因子-α治疗期间可能发生李斯特菌感染的不良事件。此外，肿瘤坏死因子-α抑制剂治疗应仅在密切的医患关系中并与专业中心合作进行。
