A Fatal Case of Concurrent Disseminated Tuberculosis, Pneumocystis Pneumonia, and Bacterial Septic Shock in a Patient with Rheumatoid Arthritis Receiving Methotrexate, Glucocorticoid, and Tocilizumab: An Autopsy Report.
Shin-Ichiro OhmuraRyuhei IshiharaAyaka MitsuiYoshiro OtsukiToshiaki MiyamotoPublished in: Case reports in rheumatology (2021)
Recently, treatment for rheumatoid arthritis has dramatically improved but increases the risk of bacterial and opportunistic infections. Herein, we report a fatal case of concurrent disseminated tuberculosis, pneumocystis pneumonia, and septic shock due to pyelonephritis caused by extended-spectrum β-lactamase-producing Escherichia coli in a patient with rheumatoid arthritis who received methotrexate, glucocorticoid, and tocilizumab. Despite undergoing intensive treatment, the patient developed respiratory failure and died after 7 days of admission. An autopsy indicated that pulmonary tuberculosis were the ultimate causes of death, while pyelonephritis was controlled.
Keyphrases
- rheumatoid arthritis
- septic shock
- pulmonary tuberculosis
- respiratory failure
- mycobacterium tuberculosis
- disease activity
- escherichia coli
- case report
- ankylosing spondylitis
- interstitial lung disease
- high dose
- extracorporeal membrane oxygenation
- mechanical ventilation
- squamous cell carcinoma
- hiv aids
- rheumatoid arthritis patients
- low dose
- combination therapy
- radiation therapy
- multidrug resistant
- acute respiratory distress syndrome