Journal List > J Rheum Dis > v.23(1) > 1064301

Yoo, Park, Park, Kim, and Hur: A Case of Sepsis Caused by Cellulitis in a Patient with Rheumatoid Arthritis after Tocilizumab Treatment

Abstract

Tocilizumab, a humanized monoclonal antibody against the interleukin-6 receptor, is therapeutically effective in patients diagnosed with rheumatoid arthritis (RA) compared with placebo. However patients treated with tocilizumab are at increased risk of several adverse effects including anaphylaxis and serious infections that may lead to hospitalization or death. Therefore, the risks and benefits of treatment with tocilizumab should be considered carefully and close monitoring of patients for development of signs and symptoms of side effects is required during and after treatment. Here, we report on a rare case of anaphylaxis and severe sepsis caused by cellulitis in a patient with RA after tocilizumab treatment.

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Figure 1.
Four days after the second intravenous administration of tocilizumab, edema and ecchymosis developed in the both lower limbs (A) and hemorrhagic blisters developed on the left dorsal foot (B).
jrd-23-55f1.tif
Figure 2.
(A) Axial T2-weighted magnetic resonance (MR), left lower leg. (B) Axial T1-weighted MR, left lower leg. (C) Axial T1-weighted post contrast MR, left lower leg. (D) Axial T2-weighted MR, left lower leg. (E) Axial T1-weighted MR, right lower leg.(F) Axial T1-weighted post contrast MR, right lower leg. Subcutaneous thickening with fluid collections (arrows) was revealed on T2-weighted images and subcutaneous tissue and superficial fascia (arrowheads) showed contrast enhancement.
jrd-23-55f2.tif
Figure 3.
On the 14th day of admission, hemorrhagic blisters on the left dorsal foot burst and a 7×7-cm ulcer developed.
jrd-23-55f3.tif
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