Abstract
A 65-year-old woman with rheumatoid arthritis treated by tocilizumab (TCZ) presented with tongue squamous cell carcinoma. While surgery was performed without any complications the aspiration pneumonia rapidly worsened by postoperative day 2 and severe pulmonary suppuration in the right lung field with infection-induced systemic inflammatory response syndrome (SIRS) was diagnosed. Antibiotic and respirator treatment improved her condition. The anti-inflammatory effect of TCZ may mask the symptoms and signs of severe infection with SIRS.
Highlights
The etiologies of rheumatoid arthritis (RA) are not fully understood, proinflammatory cytokines such as tumor necrosis factor- (TNF-) α, interleukin- (IL-) 1, and IL-6 have been shown to play a role in the pathology of RA and, as such, are potential therapeutic targets [1]
We describe here the first case of severe pulmonary suppuration from aspiration pneumonia complicated by infection-induced systemic inflammatory response syndrome (SIRS) in a postsurgical patient with tongue cancer who had received TCZ treatment for RA
Grave adverse events associated with the use of TCZ include serious infections that may lead to hospitalization or death, gastrointestinal perforation, and hypersensitivity reactions including anaphylaxis [2]
Summary
The etiologies of rheumatoid arthritis (RA) are not fully understood, proinflammatory cytokines such as tumor necrosis factor- (TNF-) α, interleukin- (IL-) 1, and IL-6 have been shown to play a role in the pathology of RA and, as such, are potential therapeutic targets [1]. Because IL6 has a pivotal role in the host defense reaction against microorganisms [3], patients treated with TCZ should be closely monitored for signs of infection. Pneumonia is a common problem in head and neck cancer (HANC) postsurgical patients [4]. A search of the literature revealed only four cases of organizing pneumonia induced by TCZ [5,6,7], while no account of aspiration pneumonia following HANC surgery could be found. We describe here the first case of severe pulmonary suppuration from aspiration pneumonia complicated by infection-induced systemic inflammatory response syndrome (SIRS) in a postsurgical patient with tongue cancer who had received TCZ treatment for RA
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