Fatal Complication of Legionella pneumophila Pneumonia in a Tocilizumab-treated Rheumatoid Arthritis Patient

Yoshiyuki Arinuma; Shinichi Nogi; Yuichi Ishikawa; Hisanori Nakayama; Atsushi Hashimoto; Akiko Komiya; Kenji Minoguchi; Ayako Horita; Ikuo Saito; Toshihiro Matsui; Shigeto Tohma

doi:10.2169/internalmedicine.54.3103

CASE REPORTS

Fatal Complication of Legionella pneumophila Pneumonia in a Tocilizumab-treated Rheumatoid Arthritis Patient

Yoshiyuki Arinuma, Shinichi Nogi, Yuichi Ishikawa, Hisanori Nakayama, Atsushi Hashimoto, Akiko Komiya, Kenji Minoguchi, Ayako Horita, Ikuo Saito, Toshihiro Matsui, Shigeto Tohma

Author information

Yoshiyuki Arinuma
Department of Rheumatology, National Hospital Organization Sagamihara National Hospital, Japan
Shinichi Nogi
Department of Rheumatology, National Hospital Organization Sagamihara National Hospital, Japan
Yuichi Ishikawa
Department of Rheumatology, National Hospital Organization Sagamihara National Hospital, Japan
Hisanori Nakayama
Department of Rheumatology, National Hospital Organization Sagamihara National Hospital, Japan
Atsushi Hashimoto
Department of Rheumatology, National Hospital Organization Sagamihara National Hospital, Japan
Akiko Komiya
Department of Laboratory Medicine, National Hospital Organization Sagamihara National Hospital, Japan
Kenji Minoguchi
Department of Allergology and Respiratory Medicine, National Hospital Organization Sagamihara National Hospital, Japan
Ayako Horita
Department of Pathology, National Hospital Organization Sagamihara National Hospital, Japan
Ikuo Saito
Department of Pathology, National Hospital Organization Sagamihara National Hospital, Japan
Toshihiro Matsui
Department of Rheumatology, National Hospital Organization Sagamihara National Hospital, Japan
Shigeto Tohma
Department of Rheumatology, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Japan

Keywords: Legionella, rheumatoid arthritis, tocilizumab, biologics, neutrophil CD64

JOURNAL OPEN ACCESS

2015 Volume 54 Issue 9 Pages 1125-1130

DOI https://doi.org/10.2169/internalmedicine.54.3103

Details

Abstract

We herein report a fatal case of Legionella pneumophila pneumonia in a tocilizumab-treated rheumatoid arthritis patient who was in a state of shock on admission but remained afebrile even during severe pneumonia. Legionella antigen was detected in the urine and neutrophil CD64 expression was highly elevated. Despite undergoing intensive treatment, the patient developed sepsis and died 12 days after admission. An autopsy indicated that while the Legionella infection had almost been controlled, a subarachnoid hemorrhage was the ultimate cause of death.

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