Fatal group A Streptococcus purpura fulminans in a child receiving TNF-α blocker
Fatal group A Streptococcus purpura fulminans in a child receiving TNF-α blocker
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DOI：
10.1007/s00431-010-1341-1
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发表时间：
2011-05-01
影响因子：
3.6
通讯作者：
Tapiero, Bruce
中科院分区：
文献类型：
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作者：
Renaud, Christian;Ovetchkine, Philippe;Tapiero, Bruce
抑制肿瘤坏死因子 α (TNF-α) 可有效治疗许多小儿自身免疫性疾病和炎症。常用的阻断 TNF-α 的生物制剂有英夫利昔单抗、依那西普和阿达木单抗。这些药物改变了成年人对风湿病的治疗，并且由于安全性和有效性已得到证明，越来越多地用于儿科患者。感染是 TNF-α 抑制最常见的不良反应。结核病等肉芽肿感染是众所周知的并发症，但也有严重细菌感染的报道。我们描述了一名 8 岁儿童因 A 族链球菌引起的暴发性紫癜致死病例，该儿童患有全身性幼年特发性关节炎，接受依那西普治疗。该病例强调了儿童严重细菌感染与 TNF-α 抑制的临床关联。儿科医生应该对接受 TNF-α 阻滞剂治疗的患者进行有关早期预警症状的教育，并且还应该在发烧时降低开始抗生素治疗的阈值。
Inhibition of tumor necrosis factor alpha (TNF-alpha) is effective in the treatment of many pediatric autoimmune diseases and inflammatory conditions. Commonly available biologic agents blocking TNF-alpha are infliximab, etanercept, and adalimumab. These agents have changed the management of rheumatic diseases in the adult population and are being used more and more in pediatric patients as safety and efficacy have been demonstrated. Infections have been the most commonly reported adverse effects of TNF-alpha inhibition. Granulomatous infections such as tuberculosis are well-known complications, but serious bacterial infections are also reported. We describe a fatal case of purpura fulminans caused by group A Streptococcus in an 8-year-old child with systemic juvenile idiopathic arthritis treated with etanercept. This case highlights the clinical association of severe bacterial infection and TNF-alpha inhibition in children. Pediatricians should educate their patients who are treated with TNF-alpha blockers regarding early warning symptoms and should also have a lower threshold for initiating antibiotic therapy in case of fever.