Nguyen Mai T T, Pødenphant Jan, Ravn Pernille
Department of Infectious Diseases, University Hospital, Odense, Denmark.
BMJ Case Rep. 2013 Jan 2;2013:bcr2012007413. doi: 10.1136/bcr-2012-007413.
We report three cases of severe disseminated Staphylococcus aureus infection in patients with rheumatoid arthritis (RA) treated with tocilizumab. Tocilizumab is a new drug, unknown to most internists, and injections given weeks before admission may not be considered by the patient as part of their 'current medical treatment', and the physician may not be aware that the patient is severely immunosuppressed. Severe infections in RA patients treated with tocilizumab may present with mild symptoms despite severe and disseminated infection and, as these patients are severely immunodeficient-intensive diagnostic work-up and early treatment should be performed. Systematic postmarketing studies are needed to clarify if there is a true increased risk of disseminated S aureus infections. We suggest caution when prescribing tocilizumab to patients with prosthetic joints and/or prior invasive S aureus infections and that patients are taught to inform health staff about their medication history and their increased risk of infection.
我们报告了3例使用托珠单抗治疗的类风湿关节炎（RA）患者发生严重播散性金黄色葡萄球菌感染的病例。托珠单抗是一种新药，大多数内科医生并不了解，入院前数周进行的注射可能未被患者视为其“当前治疗”的一部分，而且医生可能并未意识到患者处于严重免疫抑制状态。接受托珠单抗治疗的RA患者发生严重感染时，尽管感染严重且呈播散性，但可能仅表现为轻微症状，鉴于这些患者存在严重免疫缺陷，应进行强化诊断检查并尽早治疗。需要开展系统性上市后研究，以明确播散性金黄色葡萄球菌感染风险是否真的增加。我们建议，对于有假体关节和/或既往有侵袭性金黄色葡萄球菌感染的患者，在开具托珠单抗处方时应谨慎，并告知患者向医护人员说明其用药史及感染风险增加的情况。
