Hayashi Masatoshi, Kojima Toshihisa, Funahashi Koji, Kato Daizo, Matsubara Hiroyuki, Shioura Tomone, Kanayama Yasuhide, Hirano Yuji, Deguchi Masao, Kanamono Toshihisa, Ishiguro Naoki
Departments of Orthopedic Surgery and Rheumatology, Nagano Red Cross Hospital, 5-22-1 Wakasato, Nagano, 380-8582, Japan.
J Med Case Rep. 2012 Mar 9;6:81. doi: 10.1186/1752-1947-6-81.
We present a case of Streptococcus pneumoniae polyarticular septic arthritis in a patient with rheumatoid arthritis receiving a single infusion of infliximab.
A 38-year-old Japanese man with a 5-year history of seronegative rheumatoid arthritis had previously received sulphasalazine and methotrexate therapies and was on regular low-dose prednisolone therapy. Despite these treatments, his disease activity remained high and infliximab was introduced in addition to methotrexate, prednisolone, and folic acid. However, he was admitted to hospital with a fever of 40.6°C, chills, and polyarthralgia eight days after the first infusion of infliximab. His joints were swollen, painful, and warm. Laboratory data showed marked acute inflammation. He was diagnosed with bacterial septic polyarthritis, and emergency surgical joint lavage and drainage was performed at the knees along with needle aspiration and lavage of the ankles and right wrist. He was then given intravenous antibiotic therapy for 31 days. He made a good recovery and was discharged on day 37.
We believe this is the first reported case of severe pneumococcal septic arthritis requiring hospitalization in a patient treated with infliximab. S. pneumonia is now a well-recognized but uncommon cause of polyarticular septic arthritis that can lead to cessation of therapy, as in our patient's case.
我们报告一例接受单次英夫利昔单抗输注的类风湿关节炎患者发生肺炎链球菌多关节感染性关节炎的病例。
一名38岁的日本男性，有5年血清阴性类风湿关节炎病史，此前接受过柳氮磺胺吡啶和甲氨蝶呤治疗，正在接受常规低剂量泼尼松龙治疗。尽管进行了这些治疗，他的疾病活动度仍然很高，除了甲氨蝶呤、泼尼松龙和叶酸外，还加用了英夫利昔单抗。然而，在首次输注英夫利昔单抗8天后，他因发热40.6°C、寒战和多关节痛入院。他的关节肿胀、疼痛且发热。实验室数据显示有明显的急性炎症。他被诊断为细菌性感染性多关节炎，并对膝关节进行了急诊手术关节灌洗和引流，同时对踝关节和右手腕进行了穿刺抽吸和灌洗。然后他接受了31天的静脉抗生素治疗。他恢复良好，于第37天出院。
我们认为这是首例报道的在接受英夫利昔单抗治疗的患者中发生的需要住院治疗的严重肺炎球菌感染性关节炎病例。肺炎链球菌现在是公认的但不常见的多关节感染性关节炎病因，如我们患者的情况，它可导致治疗中断。
