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Opportunistic infections: case report A 53-year-old woman developed multiple opportunistic infections, including invasive nocardiosis, disseminated varicella zoster reactivation, disseminated herpes zoster infection and Pneumocystis jiroveci pneumonia during treatment with tofacitinib and methylprednisolone for ulcerative colitis [routes and durations of treatments to reactions onsets not stated]. The woman, who had a 10-year history of ulcerative colitis refractory to vedolizumab, started receiving filgotinib as part of a clinical trial. After exhibiting a response to double‐blind induction and maintenance, she experienced a flare; therefore, in August 2018, she started receiving filgotinib 200mg daily open-label. However, after 1 month, she had to withdraw from the study (due to an intermediate interferon-gamma release assays test result), and 1 month following filgotinib discontinuation, her condition flared (rebound effect). Later, in November 2018, she started receiving tofacitinib 10mg twice daily. Since total colectomy was declined, she started receiving methylprednisolone 24mg daily. After 9 weeks, the dose of methylprednisolone was tapered. Baseline endoscopy demonstrated left-sided colitis. After 4 weeks, she responded well; hence, methylprednisolone was tapered to 20mg, while tofacitinib was continued at the same dose. During week 5, she developed general malaise and discrete subcutaneous abdominal lumps. With a suspicion of cutaneous abscesses, the largest lesion on the abdominal wall was drained. She started receiving amoxicillin. Over the following days, she developed dyspnoea with minimal exertion and fever. She was hospitalised during week 8. At that time, she was receiving tofacitinib 10mg twice daily, methylprednisolone 16mg once daily and amoxicillin. She was febrile, with an oxygen saturation of 76% on room air, which rapidly increased to 95% on 2 L/min of oxygen. Subsequent examination showed coarse crackles throughout both lungs, soft and non-tender abdomen with multiple nodules and tender swelling in right preauricular region with fluctuance. A chest CT scan showed bilateral ground glass opacities. She was diagnosed with bilateral community-acquired pneumonia. The woman started receiving treatment with piperacillin/tazobactam, while tofacitinib was discontinued. As her respiratory function worsened on the subsequent day, she was transferred to the ICU. Following bronchoalveolar lavage, the doses of corticosteroids [specific drugs not stated] were increased, and high‐dose cotrimoxazole [trimethoprim/sulfamethoxazole] was added. A PCR test of bronchoalveolar lavage fluid showed presence of Pneumocystis jiroveci (Pneumocystis jiroveci pneumonia) and adenovirus. The blood cultures and cultures of the purulent fluid from the incised abscess showed presence of Nocardia farcinica. Therefore, she was switched from piperacillin/tazobactam to meropenem to treat the disseminated nocardiosis. Her respiratory failure progressed rapidly. On day 5, she was intubated and mechanically ventila