Methotrexate/tofacitinib

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Mycobacterium chimaera infection: case report In a study, a 62-year-old man developed Mycobacterium chimaera infection during immunosuppresive treatment with methotrexate and tofacitinib. The man presented with cough, weakness and fever 26 months after undergoing aortic valve replacement. At presentation, he had been receiving methotrexate and tofacitinib [dosages and routes not stated] for a presumptive diagnosis of rheumatoid arthritis. At presentation, his liver function tests were found to be abnormal, which were initially suspected to be due to methotrexate. Subsequent liver and bone marrow biopsy results revealed disseminated Mycobacterium chimaera infection. A trans-thoracic echocardiogram was found to be negative. It was later determined that the iatrogenic immunocompromised status of the patient was a risk factor for development of M. chimaera infection [durations of treatments to reaction onset not stated]. The man, therefore started receiving treatment with ethambutol, azithromycin, amikacin and rifampicin [rifampin]. After 6 weeks of starting the treatment, he underwent valve replacement [aetiology not stated]. He continued to improve thereafter. Author comment: "[Patient] had a presumptive diagnosis of an autoimmune disease, for which [patient] received immunosuppressive therapies, before the diagnosis of M. chimaera being made.. . .This also may be a contributing factor to the poor outcomes". "Mycobacterium chimaera was identified as a species within the Mycobacterium avium complex in 2004. Until recently, it was predominantly seen in immunocompromised patients." Shafizadeh N, et al. Mycobacterium chimaera Hepatitis: A New Disease Entity. American Journal of Surgical Pathology 43: 244-250, No. 2, Feb 2019. Available 803438926 from: URL: http://doi.org/10.1097/PAS.0000000000001179 - USA

0114-9954/19/1783-0001/$14.95 Adis © 2019 Springer Nature Switzerland AG. All rights reserved

Reactions 14 Dec 2019 No. 1783

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