Katana Vienna G, Carpenter Robert J, Trafeli John P, Kwan Julia M
USS Somerset (LPD-25), Medical Department, Naval Base San Diego, FPO AP 96678-1709, San Diego, CA 92113.
Department of Aerospace, Internal Medicine and Infectious Diseases, Naval Aerospace Medical Institute, 340 Hulse Road, Pensacola, FL 32508.
Mil Med. 2017 Mar;182(3):e1880-e1882. doi: 10.7205/MILMED-D-16-00149.
Psoriatic patients on tumor necrosis factor alpha inhibitors (TNFi) may be at increased risk for upper respiratory tract infections, including chronic rhino-sinusitis (CRS). Rarely, CRS can progress to orbital cellulitis (OC), an emergent ophthalmic complication wherein respiratory flora from paranasal sinus disease intrude the retro-orbital space.
Single case report.
We report the first case, to our knowledge, of an invasive sinusitis that rapidly evolved into OC in a patient receiving adalimumab treatment for plaque psoriasis and psoriatic arthritis. After TNFi withdrawal and appropriate medical and surgical intervention, the patient fully recovered. However, on resumption of TNFi therapy, symptoms of recalcitrant CRS returned.
More investigation is needed to explore how TNFi might predispose to chronic, refractory rhino-sinusitis and subsequent progression to OC. Military physicians and other medical providers should be aware of this proposed new disease entity and the potential for rapidly evolving and invasive infections in immunocompromised patients. Screening and monitoring for chronic infectious disease, such as CRS before initiating and during TNFi therapy is warranted.
使用肿瘤坏死因子α抑制剂（TNFi）的银屑病患者发生上呼吸道感染的风险可能会增加，包括慢性鼻-鼻窦炎（CRS）。CRS极少会进展为眼眶蜂窝织炎（OC），这是一种紧急的眼科并发症，鼻窦疾病的呼吸道菌群会侵入眶后间隙。
单病例报告。
据我们所知，我们报告了首例在接受阿达木单抗治疗斑块状银屑病和银屑病关节炎的患者中，侵袭性鼻窦炎迅速演变为OC的病例。停用TNFi并进行适当的药物和手术干预后，患者完全康复。然而，在恢复TNFi治疗后，顽固性CRS症状复发。
需要更多研究来探讨TNFi如何导致慢性难治性鼻-鼻窦炎以及随后进展为OC。军队医生和其他医疗服务提供者应意识到这种新提出的疾病实体以及免疫功能低下患者发生快速演变和侵袭性感染的可能性。在开始TNFi治疗前和治疗期间对慢性传染病如CRS进行筛查和监测是有必要的。
