Pneumococcal meningitis and etanercept—chance or association?

• Published in: The Journal of infection Vol. 51; no. 2; pp. E49 - E51
• Main Authors: Killingley, B., Carpenter, V., Flanagan, K., Pasvol, G.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-08-2005
• Subjects: Antirheumatic Agents - adverse effects; Ceftriaxone - administration & dosage; Ciprofloxacin - administration & dosage; Disease Susceptibility; Etanercept; Female; Humans; Immunoglobulin G - adverse effects; Immunosuppressive Agents - adverse effects; Infusions, Intravenous; Meningitis, Pneumococcal - diagnosis; Meningitis, Pneumococcal - drug therapy; Meningitis, Pneumococcal - etiology; Meningitis, Pneumococcal - immunology; Middle Aged; Otitis Media - complications; Otitis Media - diagnosis; Otitis Media - immunology; Otitis Media - microbiology; Pneumococcal meningitis; Receptors, Tumor Necrosis Factor; Rheumatoid arthritis; Streptococcus pneumoniae; Streptococcus pneumoniae - drug effects; Streptococcus pneumoniae - immunology; Streptococcus pneumoniae - isolation & purification; Treatment Outcome; Etanercept; Rheumatoid arthritis; Pneumococcal meningitis; Streptococcus pneumoniae
• ISSN: 0163-4453; 1532-2742
• DOI: 10.1016/j.jinf.2004.08.015

Rheumatoid arthritis is a severe deforming chronic disease which has major implications for mortality and quality of life. Agents with anti-tumour necrosis factor alpha (TNFα) activity are a new modality of therapy, which can significantly reduce the acute inflammation in this condition. However, TNFα is a cytokine involved in initiating the protective immune response; consequently, patients receiving this therapy are at increased risk of infection. Etanercept is a recombinant form of the p75 TNF receptor (TNF-RII) dimerised by fusion with a portion of the human IgG1 Fc tail with anti-TNFα activity. We report the first case of a patient with rheumatoid arthritis who developed pneumococcal meningitis whilst on etanercept, suggesting a possible association between etanercept and this severe life threatening infection.