Elsevier

Joint Bone Spine

Volume 74, Issue 2, March 2007, Pages 184-186
Joint Bone Spine

Case report
Cat scratch disease during etanercept therapy

https://doi.org/10.1016/j.jbspin.2006.05.017Get rights and content

Abstract

Lymphadenopathy in a patient taking TNFα antagonist therapy may indicate lymph node tuberculosis or a hematological malignancy. Although histological evidence of granuloma suggests tuberculosis, many other infections responsible for granulomatous reactions have been reported in patients on TNFα antagonist therapy. We report a case of granulomatous lymphadenopathy due to Bartonella henselae in a patient taking etanercept to treat ankylosing spondylitis.

Introduction

The development of lymphadenopathy during TNFα antagonist therapy may reveal tuberculosis or a hematological malignancy. Although histological evidence of granuloma suggests tuberculosis, many other infections responsible for granulomatous reactions have been reported in patients on TNFα antagonist therapy. We report a case in which the development of granulomatous lymphadenopathy in a patient taking etanercept to treat ankylosing spondylitis indicated Bartonella henselae infection.

Section snippets

Case report

A 50-year-old man was admitted in July 2005, 3 weeks after the development of cervical lymphadenopathy with a fever. He had a history of ankylosing spondylitis diagnosed at 17 years of age and responsible for hip involvement that eventually required bilateral arthroplasty. Etanercept (Enbrel®) was started in 2003 to control marked disease activity (BASDAI, 90.2/100; erythrocyte sedimentation rate [ESR], 50 mm/h; and C-reactive protein [CRP] level, 110 mg/L). Cervical lymphadenopathy developed in

Discussion

TNFα plays a pivotal role in immune responses to infections, most notably those due to intracellular organisms. Epidemiological data, together with anecdotal case reports, suggest an association between TNFα antagonist therapy and granulomatous infections [1]. A study of data collected by the Adverse Event Reporting System of the US Food and Drug Administration from January 1998 to September 2002 showed a higher rate of granulomatous infections with infliximab (239/100,000 patients) than with

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