Case reportCat scratch disease during etanercept therapy
Introduction
The development of lymphadenopathy during TNFα antagonist therapy may reveal tuberculosis or a hematological malignancy. Although histological evidence of granuloma suggests tuberculosis, many other infections responsible for granulomatous reactions have been reported in patients on TNFα antagonist therapy. We report a case in which the development of granulomatous lymphadenopathy in a patient taking etanercept to treat ankylosing spondylitis indicated Bartonella henselae infection.
Section snippets
Case report
A 50-year-old man was admitted in July 2005, 3 weeks after the development of cervical lymphadenopathy with a fever. He had a history of ankylosing spondylitis diagnosed at 17 years of age and responsible for hip involvement that eventually required bilateral arthroplasty. Etanercept (Enbrel®) was started in 2003 to control marked disease activity (BASDAI, 90.2/100; erythrocyte sedimentation rate [ESR], 50 mm/h; and C-reactive protein [CRP] level, 110 mg/L). Cervical lymphadenopathy developed in
Discussion
TNFα plays a pivotal role in immune responses to infections, most notably those due to intracellular organisms. Epidemiological data, together with anecdotal case reports, suggest an association between TNFα antagonist therapy and granulomatous infections [1]. A study of data collected by the Adverse Event Reporting System of the US Food and Drug Administration from January 1998 to September 2002 showed a higher rate of granulomatous infections with infliximab (239/100,000 patients) than with
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