Reactions 1704, p13 - 2 Jun 2018 Various toxicities: 2 case reports A 70-year-old woman developed hepatosplenic bartonella infection during treatment with abatacept, and a 23-year-old woman developed cat scratch disease (CSD), Fusobacterium necrophorum infection and Lemierre syndrome during treatment with golimumab [dosages, routes, durations of treatments to reactions onsets not stated]. The 70-year-old woman, who received treatment with abatacept for the treatment of rheumatoid arthritis, presented with fever for 3 weeks. Laboratory results showed a WBC 3 3 count of 3100 /mm , platelet count of 58000 /mm and haemoglobin of 8.7 g/dL. An MRI scan of the abdomen showed splenomegaly with multiple focal abscesses. She had recently adopted a kitten. Serology was positive for B. henselae with an IgG titer of 1/10240. On liver biopsy, necrotising granulomatous hepatitis was observed along with positive Warthin-Starry staining. A diagnosis of hepatosplenic bartonella infection was confirmed by a positive PCR. Her treatment with abatacept was withdrawn. She was treated with rifampicin, azithromycin and doxycycline. After 4 weeks complete clinical improvement was observed. The 23-year-old woman, who received treatment with golimumab for the treatment of ankylosing spondylitis, presented with fever and a large left cervical lymphadenopathy for 2 days. Multiple enlarged lymph nodes of the left cervical chain were evident from a CT scan. She was a recent owner of four 9-month-old cats. She was suspected to have CSD. Serology for B. henselae was requested. Treatment with golimumab was withdrawn. Her condition worsened after three days and chills, dysphagia or new odynophagia. A large retropharyngeal abscess with left internal jugular vein thrombophlebitis was revealed by a CT scan. Serology for B. Henselae was positive for IgM titer. Upon repeat serology, the IgG titer was found to be increased. Blood cultures were positive for Fusobacterium necrophorum. A confirmed diagnosis of CSD followed by Lemierre syndrome was made. She received targeted antibiotic therapy and the abscess was surgically drained. Consequently, complete recovery was noted. Author comment: "Biological agents have revolutionized the treatment of rheumatic diseases. However, they may compromise host defense mechanisms and increase the rates of usual and unusual infections. We report 2 cases of patients receiving abatacept and golimumab respectively, presenting with complicated Bartonella henselae infections." Rossi C, et al. Beware the cat: Bartonella henselae infections and biologic therapies. Joint Bone Spine 85: 381-382, No. 3, May 2018. Available from: URL: https://doi.org/10.1016/j.jbspin.2017.05.015 - Belgium 803323460 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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