Fatal group A Streptococcus purpura fulminans in a child receiving TNF-ل blocker
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Christian Renaud & Philippe Ovetchkine & Patricia Bortolozzi & Claire Saint-Cyr & Bruce Tapiero
- چاپ و سال / کشور: 2011
Description
Inhibition of tumor necrosis factor alpha (TNF-ل) is effective in the treatment of many pediatric autoimmune diseases and inflammatory conditions. Commonly available biologic agents blocking TNF-ل are infliximab, etanercept, and adalimumab. These agents have changed the management of rheumatic diseases in the adult population and are being used more andmore in pediatric patients as safety and efficacy have been demonstrated. Infections have been the most commonly reported adverse effects of TNF-ل inhibition. Granulomatous infections such as tuberculosis are wellknown complications, but serious bacterial infections are also reported.We describe a fatal case of purpura fulminans caused by group A Streptococcus in an 8-year-old child with systemic juvenile idiopathic arthritis treated with etanercept. This case highlights the clinical association of severe bacterial infection and TNF-ل inhibition in children. Pediatricians should educate their patients who are treated with TNF-ل blockers regarding early warning symptoms and should also have a lower threshold for initiating antibiotic therapy in case of fever.
Eur J Pediatr (2011) 170:657–660 DOI 10.1007/s00431-010-1341-1 Received: 29 July 2010 / Accepted: 20 October 2010 / Published online: 10 November 2010
