Nuñez-Cornejo C, Borrás-Blasco J, Gracia-Perez A, Rosique-Robles J D, Lopez-Camps V, Casterã E, Abad F J
Rehabilitation Section, Hospital de Sagunto, Avenida Ramon y Cajal s/n, Sagunto (Valencia), Spain.
Int J Clin Pharmacol Ther. 2008 Apr;46(4):193-7. doi: 10.5414/cpp46193.
To report a case of septic shock and community-acquired pneumonia in a patient with psoriatic arthritis receiving treatment with etanercept. PATIENT DETAILS: A 65-year-old woman diagnosed as having psoriatic arthritis had received treatment with etanercept. Chest X-ray studies were normal and the tuberculin skin test was negative. Two months after etanercept therapy, the patient presented to our emergency department with fever, cough, chest pain and generalized weakness. Chest radiography revealed a right pulmonary infiltrate. Her condition rapidly deteriorated and she went into shock with a further drop in her blood pressure, tachycardia and tachypnea. She was intubated, mechanically ventilated and was treated with fluids, cardioversion and amiodarone. Empiric therapy with levofloxacin, amikacin and cefepime were initiated. In the urinalysis, the result of a rapid test for Streptococcus pneumoniae was positive. Etanercept treatment was suspended due to a possible adverse reaction associated with this drug. At the start of therapy her clinical condition improved slowly. On Day 28, the patient was afebrile and she was discharged from the intensive care unit.
Most of the infections associated with etanercept therapy have been reported in patients with rheumatoid arthritis. Based on our observations, etanercept was the possible offender in the development of septic shock and respiratory failure in community-acquired pneumonia. There was a temporal relationship between exposure to the drug and onset of symptoms. Etanercept was the only drug administered before the septic shock developed. Based on the Naranjo algorithm, the adverse reaction could be considered possible.
Patients initiated on etanercept should be counseled and receive appropriate screening before drug initiation. All febrile and newly occurring concomitant illnesses should be promptly evaluated. General practitioners should discontinue etanercept treatment and institute prompt and aggressive intervention if infection develops.
报告1例接受依那西普治疗的银屑病关节炎患者发生感染性休克和社区获得性肺炎的病例。
一名65岁女性被诊断为银屑病关节炎，接受了依那西普治疗。胸部X线检查正常，结核菌素皮肤试验阴性。依那西普治疗两个月后，患者因发热、咳嗽、胸痛和全身无力就诊于我院急诊科。胸部X线检查显示右肺浸润。她的病情迅速恶化，出现休克，血压进一步下降、心动过速和呼吸急促。她被插管、机械通气，并接受了补液、心脏复律和胺碘酮治疗。开始经验性使用左氧氟沙星、阿米卡星和头孢吡肟治疗。尿液分析中，肺炎链球菌快速检测结果呈阳性。由于可能与此药物相关的不良反应，停用了依那西普治疗。治疗开始时，她的临床状况缓慢改善。第28天，患者体温正常，从重症监护病房出院。
大多数与依那西普治疗相关的感染报告发生在类风湿关节炎患者中。根据我们的观察，依那西普可能是社区获得性肺炎患者发生感染性休克和呼吸衰竭的原因。药物暴露与症状发作之间存在时间关系。依那西普是在感染性休克发生之前唯一使用的药物。根据纳兰霍算法，该不良反应可被认为是可能的。
开始使用依那西普治疗的患者应接受咨询，并在开始用药前接受适当的筛查。所有发热和新出现的伴随疾病都应及时评估。如果发生感染，全科医生应停用依那西普治疗，并立即进行积极干预。
