C reactive protein may not be reliable as a marker of severe bacterial infection in patients receiving tocilizumab.
C reactive protein may not be reliable as a marker of severe bacterial infection in patients receiving tocilizumab.
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DOI：
10.1136/bcr-2013-010423
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发表时间：
2013-10-31
期刊：
影响因子：
0.9
通讯作者：
Lawson, Tom
中科院分区：
文献类型：
--
作者：
Bari, Syed Farhan;Khan, Afsha;Lawson, Tom
这是一例65岁男性，血清阳性糜烂性类风湿关节炎（RA），甲氨蝶呤、磺胺氮嗪、低剂量强的松龙和每月输注托珠单抗控制良好。患者有3周的左膝疼痛和肿胀史，并逐渐加重，不能负重。他全身健康，生命体征正常。检查证实有积液和吸入，外观浑浊。C反应蛋白（CRP）正常。他接受了经验性的抗生素治疗。滑液和血液培养证实为金黄色葡萄球菌感染。他完成了6周的抗生素疗程，症状完全缓解。在整个治疗过程中，他的CRP保持正常，这可能是之前使用托珠单抗治疗的结果。
This is a case of a 65-year-old man with seropositive erosive rheumatoid arthritis (RA), well controlled on methotrexate, sulfasalazine, low-dose prednisolone and monthly infusions of tocilizumab. He presented with a 3-week history of pain and swelling in his left knee, gradually increasing in severity with an inability to bear weight. He was systemically well with normal vital signs. Examination confirmed an effusion and aspiration was turbid in appearance. C reactive protein (CRP) was normal. He was treated empirically with antibiotics. Synovial fluid and blood cultures confirmed Staphylococcus aureus infection. He completed a 6 weeks course of antibiotics with complete resolution of symptoms. Throughout the treatment his CRP remained normal which is likely to have been the result of prior treatment with tocilizumab.