Asunto(s)
Lesiones Encefálicas/complicaciones , Delirio/diagnóstico , Técnicas de Diagnóstico Neurológico/normas , Lesiones Encefálicas/psicología , Delirio/etiología , Escala de Coma de Glasgow , Humanos , Unidades de Cuidados Intensivos/normas , Tamizaje Masivo/métodos , Tamizaje Masivo/normas , Estudios Prospectivos , Quebec , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
Two cases of fulminant pulmonary legionellosis, complicated by prolonged intensive care unit stays and acute respiratory distress syndrome, and who were recently treated with infliximab for Crohn's disease, are described. A review of the literature revealed three additional cases in patients with inflammatory bowel disease, and a total of 22 cases of Legionella pneumophila pneumonia in the context of treatment with antitumour necrosis (TNF)-alpha medications. The median age of the patients was 49 years, and men and women were affected equally. The case fatality rate was 14% (three of 22). Early recognition and treatment of this anti-TNF-alpha-related complication would likely result in reduced mortality and morbidity. Physicians prescribing anti-TNF-alpha drugs should be aware of this association.
Asunto(s)
Antiinflamatorios/efectos adversos , Anticuerpos Monoclonales/efectos adversos , Enfermedad de los Legionarios/etiología , Adulto , Anciano , Antiinflamatorios/uso terapéutico , Anticuerpos Monoclonales/uso terapéutico , Enfermedad de Crohn/tratamiento farmacológico , Femenino , Humanos , Infliximab , Legionella pneumophila/aislamiento & purificación , Enfermedad de los Legionarios/mortalidad , Masculino , Persona de Mediana Edad , Neumonía Bacteriana/etiología , Neumonía Bacteriana/mortalidadRESUMEN
BACKGROUND: As immunomodulatory therapies such as recombinant human interferon beta gain clinical applicability, patients are likely to experience some of their numerous cutaneous adverse effects at injection sites. We describe a case of interferon beta-induced septal panniculitis. OBSERVATIONS: A 43-year-old woman with multiple sclerosis treated with subcutaneous interferon beta presented with right lower abdominal quadrant pain, fever, and an indurated McBurney point. An abdominal computed tomographic scan showed an inflammatory subcutaneous fat infiltration reaching the surface of the right lateral rectus muscle. The patient was brought to the operating room, where a laparoscopic appendectomy was performed. She returned a week later unimproved. The infiltration near a site of subcutaneous injection progressed with areas of liquefaction. Histologic examination of a deep cutaneous biopsy specimen revealed a septal panniculitis without vasculitis. CONCLUSIONS: Panniculitides encompass various clinical syndromes characterized by inflammation of the fibrous septae, fatty lobules, or both components of the subcutaneous tissue. Interferon beta-1b should be considered among the list of putative agents.