Format

Send to

Choose Destination
See comment in PubMed Commons below
BMJ Case Rep. 2012 May 23;2012. pii: bcr0220125835. doi: 10.1136/bcr.02.2012.5835.

The absence of typical pneumonia symptoms in a patient with rheumatoid arthritis during tocilizumab and steroid treatment.

Author information

1
Department of Emergency and Disaster Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan. yyanaga@juntendo.ac.jp

Abstract

A 78-year-old woman with rheumatoid arthritis while being treated with tocilizumab and steroid treatment presented with pharyngeal pain and general malaise. She felt chills and vomited while waiting in the waiting room, in addition to urinary incontinence. An immediate evaluation of her condition indicated that she was in shock and a physical examination revealed moist rales in the right lung field. Her white cell count and C reactive protein level were within normal limits; however, a radiological study indicated pneumonia. Antibiotic treatment resulted in improvement of her condition. Blood culture later revealed bacteraemia due to Streptococcus pneumoniae. The anti-inflammatory effect of tocilizumab and steroid treatment may mask the typical symptoms and signs of infection, so physicians must be aware of the potential for hidden infection when such patients present with an unidentified complaint.

PMID:
22669023
PMCID:
PMC3369370
DOI:
10.1136/bcr.02.2012.5835
[Indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for HighWire Icon for PubMed Central
    Loading ...
    Support Center