A Fatal Case of Concurrent Disseminated Tuberculosis, Pneumocystis Pneumonia, and Bacterial Septic Shock in a Patient with Rheumatoid Arthritis Receiving Methotrexate, Glucocorticoid, and Tocilizumab: An Autopsy Report | Zendy

Shinichiro Ohmura | Zendy; Ryuhei Ishihara | Zendy; Ayaka Mitsui | Zendy; Yoshiro Otsuki | Zendy; Toshiaki Miyamoto | Zendy

Open Access

A Fatal Case of Concurrent Disseminated Tuberculosis, Pneumocystis Pneumonia, and Bacterial Septic Shock in a Patient with Rheumatoid Arthritis Receiving Methotrexate, Glucocorticoid, and Tocilizumab: An Autopsy Report

Author(s) -

Shinichiro Ohmura,

Ryuhei Ishihara,

Ayaka Mitsui,

Yoshiro Otsuki,

Toshiaki Miyamoto

Publication year - 2021

Publication title -

case reports in rheumatology

Language(s) - English

Resource type - Journals

eISSN - 2090-6889

pISSN - 2090-6897

DOI - 10.1155/2021/7842049

Subject(s) - medicine , tocilizumab , rheumatoid arthritis , pneumocystis pneumonia , septic shock , methotrexate , pneumonia , tuberculosis , sepsis , autopsy , bacterial pneumonia , respiratory failure , pneumocystis jirovecii , pathology

Recently, treatment for rheumatoid arthritis has dramatically improved but increases the risk of bacterial and opportunistic infections. Herein, we report a fatal case of concurrent disseminated tuberculosis, pneumocystis pneumonia, and septic shock due to pyelonephritis caused by extended-spectrum β -lactamase-producing Escherichia coli in a patient with rheumatoid arthritis who received methotrexate, glucocorticoid, and tocilizumab. Despite undergoing intensive treatment, the patient developed respiratory failure and died after 7 days of admission. An autopsy indicated that pulmonary tuberculosis were the ultimate causes of death, while pyelonephritis was controlled.

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