Document Detail

A life-threatening abscess in a patient treated with a tumour necrosis factor-alpha antagonist: a case report.
MedLine Citation:
PMID:  19721159     Owner:  NLM     Status:  MEDLINE    
A 25-year-old man with a 3-year history of ankylosing spondylitis presented with a sudden onset of pain in his left thigh. His ankylosing spondylitis had been treated for 2 years with the tumour necrosis factor-alpha (TNF-alpha) antagonist infliximab. The initial diagnosis was a muscular tear, and non-steroidal anti-inflammatory drugs were prescribed. 40 days later, the patient had tender swelling with warmth and light redness on his left thigh. His knee function had decreased markedly. His C-reactive protein level was 320 mg/l and white cell count was 30.4 x10(9)/l, indicating severe infection. Magnetic resonance imaging revealed a loculated fluid collection in the quadriceps musculature measuring 30 cm. Hyperintensity seen on T1-weighted images was suggestive of infection. The infliximab therapy was stopped and repeated debridement and drainage performed, with about 2.5 litres of pus evacuated. Flucloxacillin was administered for 2 weeks. The wound was closed 9 days later. The patient was discharged 20 days after surgery. An alternative immunosuppressive therapy--abatacept--was introduced. At the 18-month follow-up, the patient reported only light discomfort in the thigh during exercise, with a mildly impaired range of knee movement. No infectious complications recurred.
Dieter Cadosch; Lisa Neukom; Oliver P Gautschi; Rene Zellweger
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Journal of orthopaedic surgery (Hong Kong)     Volume:  17     ISSN:  1022-5536     ISO Abbreviation:  J Orthop Surg (Hong Kong)     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-09-01     Completed Date:  2010-02-26     Revised Date:  2013-05-24    
Medline Journal Info:
Nlm Unique ID:  9440382     Medline TA:  J Orthop Surg (Hong Kong)     Country:  China    
Other Details:
Languages:  eng     Pagination:  227-30     Citation Subset:  IM    
Department of Orthopaedic and Trauma Surgery, Royal Perth Hospital, Perth, Australia.
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MeSH Terms
Abscess / chemically induced*,  microbiology,  therapy*
Anti-Inflammatory Agents / adverse effects*
Antibodies, Monoclonal / adverse effects*
Combined Modality Therapy
Diagnosis, Differential
Immunoconjugates / therapeutic use
Immunosuppressive Agents / therapeutic use
Magnetic Resonance Imaging
Spondylitis, Ankylosing / drug therapy*
Young Adult
Reg. No./Substance:
0/Anti-Inflammatory Agents; 0/Antibodies, Monoclonal; 0/Immunoconjugates; 0/Immunosuppressive Agents; 0/infliximab; 7D0YB67S97/abatacept

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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