Fatal complication of Legionella pneumophila pneumonia in a tocilizumab-treated rheumatoid arthritis patient.

Abstract

We herein report a fatal case of Legionella pneumophila pneumonia in a tocilizumab-treated rheumatoid arthritis patient who was in a state of shock on admission but remained afebrile even during severe pneumonia. Legionella antigen was detected in the urine and neutrophil CD64 expression was highly elevated. Despite undergoing intensive treatment, the patient developed sepsis and died 12 days after admission. An autopsy indicated that while the Legionella infection had almost been controlled, a subarachnoid hemorrhage was the ultimate cause of death.

• Authors: Yoshiyuki Arinuma, Shinichi Nogi, Yuichi Ishikawa, Hisanori Nakayama, Atsushi Hashimoto, Akiko Komiya, Kenji Minoguchi, Ayako Horita, Ikuo Saito, Toshihiro Matsui, Shigeto Tohma
• Journal: Internal medicine (Tokyo, Japan) (Intern Med) Vol. 54 Issue 9 Pg. 1125-30 ( 2015) ISSN: 1349-7235 [Electronic] Japan
• PMID: 25948362 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antibodies, Monoclonal, Humanized
• Antirheumatic Agents
• tocilizumab

Topics

• Antibodies, Monoclonal, Humanized (administration & dosage)
• Antirheumatic Agents (administration & dosage)
• Arthritis, Rheumatoid (complications, drug therapy, immunology)
• Fatal Outcome
• Hospitalization
• Humans
• Immunocompromised Host
• Legionella pneumophila (isolation & purification)
• Legionnaires' Disease (etiology, immunology, microbiology)
• Male
• Middle Aged
• Sepsis (complications, immunology, microbiology)
• Subarachnoid Hemorrhage (microbiology)