Chandrakumaran Anchalia, Malik Manpreet, Stevens Michael P, Abbate Antonio
Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, VA, USA.
Division of Hospital Medicine, Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, VA, USA.
Eur Heart J Case Rep. 2018 Sep 4;2(3):yty098. doi: 10.1093/ehjcr/yty098. eCollection 2018 Sep.
Canakinumab is a human monoclonal interleukin-1 antibody that has been studied in the Canakinumab Anti-Inflammatory Thrombosis Outcome Study (CANTOS) trial and shown to prevent recurrent cardiovascular events, while increasing the incidence of neutropenia and risk of severe infections.
This is a case report of a locally invasive aspergillus infection in a patient with uncontrolled diabetes mellitus who was receiving canakinumab for 3.5 years as part of the CANTOS trial. He presented with headaches and left eye pain and was found to have a large left ethmoid sinus mass extending into the orbit on computed tomography scan of the head. Cultures from an endoscopic biopsy of left ethmoid sinus grew . Canakinumab was discontinued, and he was discharged on voriconazole with improvement in his headaches and left eye pain.
The anti-inflammatory properties of canakinumab could have blunted the patient's immune response allowing the mycetoma to invade adjacent tissue. If canakinumab was approved for the secondary prevention of cardiovascular events then it is important to be cognizant of its potential to delay the presentation of any infection.
卡那单抗是一种人源单克隆白细胞介素 -1 抗体，已在卡那单抗抗炎血栓形成结果研究（CANTOS）试验中进行研究，结果显示其可预防心血管事件复发，但会增加中性粒细胞减少的发生率和严重感染的风险。
这是一例糖尿病控制不佳患者发生局部侵袭性曲霉感染的病例报告，该患者作为 CANTOS 试验的一部分接受了 3.5 年的卡那单抗治疗。他出现头痛和左眼疼痛，头部计算机断层扫描发现左侧筛窦有一个大肿块延伸至眼眶。左侧筛窦内镜活检培养物生长出……停用卡那单抗后，他出院时服用伏立康唑，头痛和左眼疼痛有所改善。
卡那单抗的抗炎特性可能削弱了患者的免疫反应，使足菌肿得以侵袭邻近组织。如果卡那单抗被批准用于心血管事件的二级预防，那么认识到其可能延迟任何感染的表现很重要。
