Adalimumab/mercaptopurine Reactions 1680, p18 - 2 Dec 2017 Invasive salmonellosis caused by Salmonella choleraesuis and recurrent bacteraemia: case report A 52-year-old man developed invasive salmonellosis caused by Salmonella choleraesuis and recurrent bacteraemia during treatment with adalimumab [Humira] and mercaptopurine [6-mercaptopurine]. The man, who had a history of Crohn’s disease, liver cirrhosis and non-alcoholic steatohepatitis, presented in April 2011 with a four-day history of fever, chills and severe headache, which started approximately one week after his return from Dominican Republic where he had travelled for a 10 day vacation. He also had nausea and vomiting. He did not receive any prophylaxis or vaccinations prior to his travel. He was on an injection of adalimumab 40mg weekly and oral mercaptopurine 75mg daily for the previous 2 years for Crohn’s disease, which was diagnosed more than 20 years prior. Physical examination revealed a fever of 103.8°C. Laboratory tests revealed a WBC count of 3,500 /µL and two blood cultures grew Salmonella choleraesuis susceptible to ceftriaxone and ciprofloxacin. The man was treated with ceftriaxone with a good clinical response and his fever resolved within 36 hours. Also, repeat blood cultures two days after antibiotics therapy showed no growth. He was discharged home on a two week course of ciprofloxacin. However, he was readmitted one month later due to similar symptoms as well as recurrent bacteraemia due to the same organism. His adalimumab was temporarily stopped and he was discharged home on a one-month course of ceftriaxone. He did well without any recurrence on six months follow-up. Author comment: "The index patient had multiple immunosuppressing conditions besides being on a biologic agent that increased his risk for invasive disease." "S. choleraesuis causes primary bacteremia . . . especially in the immunosuppressed, older patient" "[Immunosuppression] is the most significant risk factor for invasive salmonellosis due to this organism" "There is an increasing report of invasive salmonellosis cases among patients on [anti-TNF-α agents]" Eke UA, et al. Invasive salmonellosis by the very rare Salmonella choleraesuis in a returning traveler on a tumor necrosis factor-alpha inhibitor. Case Reports in Medicine 2014: 23 Feb 2014. Available from: URL: http:// - USA 803285243 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680 Reactions Weekly Springer Journals


Reactions Weekly , Volume 1680 (1) – Dec 2, 2017
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Springer International Publishing
Copyright © 2017 by Springer International Publishing AG, part of Springer Nature
Medicine & Public Health; Drug Safety and Pharmacovigilance; Pharmacology/Toxicology
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