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Disseminated Nocardiosis Associated with Treatment with Infliximab in a Patient with Ulcerative Colitis.

Abstract BACKGROUND Opportunistic infections may occur when patients with inflammatory bowel disease (IBD) are treated with tumor necrosis factor (TNF)-alpha inhibitors. With the increasing use of new immunosuppressant drugs, the incidence of opportunistic or atypical infections is also increasing, including with Nocardia spp. A high level of awareness of atypical infections is warranted in immunosuppressed patients. CASE REPORT A 57-year-old female African American, with a past medical history of ulcerative colitis (UC) and arthritis, was treated with infliximab and prednisone. She presented to the emergency department with acute onset of chest pain, shortness of breath, and a two-week history of a productive cough. Examination showed hypoxia, tachypnea, decreased and coarse bilateral breath sounds, and fluctuant, tender, erythematous masses on her trunk and groin. Laboratory investigations showed a leukocytosis with a left shift. She was initially treated for presumed community-acquired pneumonia (CAP). However, blood cultures grew Nocardia farcinica and treatment with trimethoprim-sulfamethoxazole (TMP-SMX) was begun, which was complicated by severe symptomatic hyponatremia. Following recovery from infection and resolution of the hyponatremia, the patient was discharged to a senior care facility, but with continued treatment with TMP-SMX. CONCLUSIONS To our knowledge, this is the first case of disseminated nocardiosis associated with infliximab treatment in a patient with ulcerative colitis. As with other forms of immunosuppressive therapy, patients who are treated with infliximab should be followed closely due to the increased risk of atypical infections. When initiating antibiotic therapy, careful monitoring of possible side effects should be done.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title the american journal of case reports
Publication Year Start




PMID- 29263313
OWN - NLM
STAT- In-Process
LR  - 20180103
IS  - 1941-5923 (Electronic)
IS  - 1941-5923 (Linking)
VI  - 18
DP  - 2017 Dec 21
TI  - Disseminated Nocardiosis Associated with Treatment with Infliximab in a Patient
      with Ulcerative Colitis.
PG  - 1365-1369
AB  - BACKGROUND Opportunistic infections may occur when patients with inflammatory
      bowel disease (IBD) are treated with tumor necrosis factor (TNF)-alpha
      inhibitors. With the increasing use of new immunosuppressant drugs, the incidence
      of opportunistic or atypical infections is also increasing, including with
      Nocardia spp. A high level of awareness of atypical infections is warranted in
      immunosuppressed patients. CASE REPORT A 57-year-old female African American,
      with a past medical history of ulcerative colitis (UC) and arthritis, was treated
      with infliximab and prednisone. She presented to the emergency department with
      acute onset of chest pain, shortness of breath, and a two-week history of a
      productive cough. Examination showed hypoxia, tachypnea, decreased and coarse
      bilateral breath sounds, and fluctuant, tender, erythematous masses on her trunk 
      and groin. Laboratory investigations showed a leukocytosis with a left shift. She
      was initially treated for presumed community-acquired pneumonia (CAP). However,
      blood cultures grew Nocardia farcinica and treatment with
      trimethoprim-sulfamethoxazole (TMP-SMX) was begun, which was complicated by
      severe symptomatic hyponatremia. Following recovery from infection and resolution
      of the hyponatremia, the patient was discharged to a senior care facility, but
      with continued treatment with TMP-SMX. CONCLUSIONS To our knowledge, this is the 
      first case of disseminated nocardiosis associated with infliximab treatment in a 
      patient with ulcerative colitis. As with other forms of immunosuppressive
      therapy, patients who are treated with infliximab should be followed closely due 
      to the increased risk of atypical infections. When initiating antibiotic therapy,
      careful monitoring of possible side effects should be done.
FAU - Garner, Orlando
AU  - Garner O
AD  - Department of Internal Medicine, Texas Tech University Health Sciences Center at 
      The Permian Basin, Odessa, TX, USA.
FAU - Ramirez-Berlioz, Ana
AU  - Ramirez-Berlioz A
AD  - Department of Internal Medicine, Texas Tech University Health Sciences Center at 
      The Permian Basin, Odessa, TX, USA.
FAU - Iardino, Alfredo
AU  - Iardino A
AD  - Department of Internal Medicine, Texas Tech University Health Sciences Center at 
      The Permian Basin, Odessa, TX, USA.
FAU - Mocherla, Satish
AU  - Mocherla S
AD  - Department of Infectious Disease, Midland Memorial Hospital, Midland, TX, USA.
FAU - Bhairavarasu, Kalpana
AU  - Bhairavarasu K
AD  - Department of Internal Medicine, Texas Tech University Health Sciences Center at 
      The Permian Basin, Odessa, TX, USA.
LA  - eng
PT  - Journal Article
DEP - 20171221
PL  - United States
TA  - Am J Case Rep
JT  - The American journal of case reports
JID - 101489566
PMC - PMC5742452
EDAT- 2017/12/22 06:00
MHDA- 2017/12/22 06:00
CRDT- 2017/12/22 06:00
PHST- 2017/12/22 06:00 [entrez]
PHST- 2017/12/22 06:00 [pubmed]
PHST- 2017/12/22 06:00 [medline]
AID - 906391 [pii]
PST - epublish
SO  - Am J Case Rep. 2017 Dec 21;18:1365-1369.