Mycobacterial hand infections occurring postoperatively in patients treated with tumor necrosis factor-alpha inhibitors for inflammatory arthritis: report of three cases

J Hand Surg Am. 2010 Jan;35(1):104-8. doi: 10.1016/j.jhsa.2009.09.018.

Abstract

Tumor necrosis factor-alpha inhibitors are potent anti-rheumatic drugs, but there is evidence that the high level of immunosuppression they provide may also lead to a higher risk of infections. At our institution, 3 patients with inflammatory arthritis treated with tumor necrosis factor-alpha inhibitors developed mycobacterial soft tissue infections after routine hand surgery. All 3 patients required multiple surgical procedures, inpatient hospitalizations, and prolonged antibiotic multidrug therapy to clear the infections.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antibodies, Monoclonal / therapeutic use
  • Antirheumatic Agents / therapeutic use
  • Arthritis, Psoriatic / drug therapy*
  • Arthritis, Rheumatoid / drug therapy*
  • Azithromycin / therapeutic use*
  • Etanercept
  • Female
  • Hand / surgery*
  • Humans
  • Immunoglobulin G / therapeutic use
  • Infliximab
  • Male
  • Methotrexate / therapeutic use
  • Middle Aged
  • Mycobacterium Infections / diagnosis*
  • Mycobacterium Infections / drug therapy
  • Receptors, Tumor Necrosis Factor / therapeutic use
  • Tenosynovitis / drug therapy
  • Tenosynovitis / microbiology*
  • Tenosynovitis / surgery
  • Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*

Substances

  • Antibodies, Monoclonal
  • Antirheumatic Agents
  • Immunoglobulin G
  • Receptors, Tumor Necrosis Factor
  • Tumor Necrosis Factor-alpha
  • Trimethoprim, Sulfamethoxazole Drug Combination
  • Azithromycin
  • Infliximab
  • Etanercept
  • Methotrexate