A second dose of infliximab was administered the week before transfer

A second dose of infliximab was administered the week before transfer. dun traitement par anti-TNF-alpha. Lge mdian des patients tait de 49 ans et les hommes et les femmes taient affects dans une mme proportion. Le taux de mortalit Procyanidin B2 a t de 14 % (trois sur Procyanidin B2 22). La reconnaissance et le traitement prcoces de cette complication lie aux anti-TNF-alpha permettraient de rduire la mortalit et la morbidit. Les mdecins qui prescrivent des anti-TNF-alpha doivent tre au courant de ce lien. Legionella pneumophilais a ubiquitous intracellular pathogen, and a common etiological agent in community-acquired pneumonia (1). The association ofL pneumophilapneumonia with antitumour necrosis factor (TNF)-alpha has been reported previously in the literature (210) and twice before in patients receiving infliximab for Crohns disease (4,5). With the growing popularity of anti-TNF-alpha agents for the treatment of inflammatory bowel disease, it is important for physicians to be aware of this readily treatable and potentially life-threatening complication. Two cases of fulminant legionellosis associated with recent infliximab therapy in the context of Crohns disease are reported, followed by a review and synthesis of the literature describing this association. == CASE PRESENTATIONS == Both cases were transferred from the referring community hospital to the intensive care unit (ICU) of the Hpital Sacr-Cur (Montreal, Quebec) for advanced ventilatory management. At the time of transfer, the referring hospital was undergoing major renovations to its physical plant, including its water supply system. To date, three patients with nosocomialL pneumophilapneumonia have been found and local public health authorities have conducted an outbreak investigation. == Case A == A 26-year-old electrician was admitted to the referring hospital two months before transfer for investigation of chronic diarrhea, fistula-in-ano and abdominal pains. The patients medical history was significant for a motor vehicle collision and a work accident that left him with chronic lumbar spinal pain and post-traumatic stress disorder, for which he took the equivalent of 60 mg of morphine daily and was followed by psychiatry. There was no history of repeated infection or immunodeficiency. During his hospitalization at the referring hospital, he was investigated with a colonoscopy and an abdominal computed tomography scan a diagnosis of Crohns disease was tentatively made; however, the patient did not display any extraintestinal manifestations of Crohns disease. He was treated with prednisone 1 mg/kg/day and escalating doses of 6-mercaptopurine to 1 1 mg/kg/day, with no response. One month before transfer, the patient received a 5 mg/kg Mouse monoclonal to OTX2 induction dose of infliximab. One week before Procyanidin B2 transfer, he began to experience persistent fevers, with no associated symptoms. On the day of transfer, he experienced rapidly progressive respiratory failure, going from ambient air flow in the morning to severe hypoxic respiratory Procyanidin B2 failure requiring intubation from the night. On introduction to hospital, the patient was sedated and intubated. The physical exam revealed a large, muscular, young man with no losing or dermatological abnormalities. The patient was tachypneic and the lung exam exposed diffuse rales on auscultation. The abdominal and lymphatic examinations were unremarkable. There was a partially healed anal fistula. The individuals initial x-ray shown diffuse bilateral patchy and interstitial opacities (Number 1A). He was started on piperacillin-tazobactam and vancomycin modified to renal clearance, azithromycin 500 mg intravenously (IV) daily and caspofungin 50 mg IV daily. Blood was drawn for ethnicities and urine legionella and pneumococcal antigens were requested. The patient rapidly became hard to oxygenate and needed high-frequency oscillation air flow to keep up a partial pressure of oxygen of more than 60 mmHg. On day time 2 of his admission, the legionella antigen test (Inverness-Binax, USA) returned a positive result for serogroup 1L pneumophila. The patient recovered sufficiently to be extubated on day time 9 of admission. He was treated having a 21-day time course of azithromycin. He was remaining with residual severe kidney disease requiring hemodialysis secondary to acute tubular necrosis, but offers normally fully recovered. == Number 1). == AThe patient in case A offered in acute respiratory stress followingLegionella.