Infective Endocarditis with Septic Shock in a Rheumatoid Arthritis Patient being Treated with Etanercept

類風濕性關節炎是一種慢性多關節發炎性疾病，其真正的形成原因目前仍不甚清楚。生物製劑已被廣泛地應用在類風濕性關節炎的治療。其中，etanercept是一種常被使用的生物製劑，它是由第二型腫瘤壞死因子接受器與免疫球蛋白G1（IgG1）結合而成。這類生物製劑被認為有可能會增加嚴重感染的風險。在此，我們報告一個使用etanercept治療類風濕性關節炎病人所發生的感染性心內膜炎併發敗血性休克。經過適當的復甦與抗生素治療，此病患恢復良好；其主動脈瓣上的贅生物也在治療後消失不見。據我們了解，這是醫學文獻上初次報告感染性心內膜炎併發敗血性休克發生在使用etanercept治療類風濕性關節炎病人。我們提出這個報告以提醒臨床醫師在處方這類生物製劑時須特別謹慎。

關鍵字

感染性心內膜炎；類風濕性關節炎； etanercept ；敗血症；肺炎

並列摘要

Rheumatoid arthritis (RA) is a chronic inflammatory polyarticular disorder of unknown cause. Nowadays, biologic agents are widely used to treat RA. Etanercept, a tumor necrosis factor (TNF) type II receptor fused to IgG1, is one of the most commonly used biologic agents. Increased risk of serious infections is recognized as a potential side effect, of which reactivation of tuberculosis is particularly notable. We report the case of a patient with infective endocarditis complicated with septic shock, who had been receiving etanercept for his refractory RA. Through appropriate resuscitation and antibiotic treatment, the patient had a good recovery with resolution of the vegetation on the aortic valve. To the best of our knowledge, this is the first report in the medical literature describing a RA patient taking etanercept complicated with infective endocarditis. Physicians should be cautious when considering the use of biologic agents.

並列關鍵字

infective endocarditis ； rheumatoid arthritis ； etanercept ； sepsis ； pneumonia

國際替代計量

Infective Endocarditis with Septic Shock in a Rheumatoid Arthritis Patient being Treated with Etanercept

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