A Case of Sepsis Caused by Cellulitis in a Patient with Rheumatoid Arthritis after Tocilizumab Treatment

Min Seok Yoo; Ji Sang Park; Yoon Suk Park; Hye Won Kim; Jin-Wuk Hur

doi:10.4078/jrd.2016.23.1.55

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

Case Report

J Rheum Dis 2016;23(1):55-60.

Published online: 31 October 2016

DOI: https://doi.org/10.4078/jrd.2016.23.1.55

A Case of Sepsis Caused by Cellulitis in a Patient with Rheumatoid Arthritis after Tocilizumab Treatment

Min Seok Yoo, Ji Sang Park, Yoon Suk Park, Hye Won Kim, Jin-Wuk Hur

Division of Rheumatology, Department of Internal Medicine, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea

Corresponding to: Jin-Wuk Hur, Division of Rheumatology, Department of Internal Medicine, Eulji General Hospital, Eulji University College of Medicine, 68 Hangeulbiseok-ro, Nowon-gu, Seoul 01830, Korea. E-mail: rheumatism@eulji.ac.kr

Received 26 March 2015 Revised 16 April 2015 Accepted 20 April 2015

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Tocilizumab, Anaphylaxis, Cellulitis, Sepsis

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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).

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.

Figure 3.

On the 14th day of admission, hemorrhagic blisters on the left dorsal foot burst and a 7×7-cm ulcer developed.

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