Fatal Mycobacterium peregrinum pneumonia in refractory polymyositis treated with infliximab

this was a coincidental occurrence or whether the etanercept caused exacerbation of an active subclinical infection. The chronic steroid therapy with 25mg of prednisone daily should also be considered as an additional contributing factor in masking the infection. In our review of the literature only two cases of fatal sepsis associated with tumour necrosis factor alpha (TNF) blockers were reported [1, 2]. Baghai et al. [1] reported a case of fatal pneumococcal sepsis occurring in a 37-yr-old woman with rheumatoid arthritis treated with etanercept, and Herrlinger et al. [2] reported the case of a 40-yr-old woman who after six infusions of infliximab for perianal Crohn’s disease developed staphylococcal pneumonia resulting in fatal adult respiratory distress syndrome. Kroesen et al. [3] reviewed patient charts and records of the infectious disease unit for serious infections in patients with RA in the 2 yr preceding anti-TNFtherapy and during therapy. Serious infections affected 18.3% of patients treated with infliximab or etanercept. In several cases, only a few signs or symptoms indicated the severity of developing infections and sepsis; therefore a high level of suspicion of infection is necessary in patients under anti-TNFtherapy. Our experience with TNFblockers at the American University of Beirut Medical Center (a tertiary-care teaching hospital, one of the largest medical centres in Lebanon), dates back to October 2000; up to the present time around 90 patients with various rheumatic diseases have received this drug [4]. No serious infections in our series have been reported except for a case of miliary tuberculosis [5]. A thorough screening for any latent infections, besides tuberculosis, is warranted in patients prior to the initiation of TNFblocker therapy.