Abstract
A-72-year-old woman with rheumatoid arthritis (RA) was transferred to our hospital because of rapid progressive hypoxemia. She had RA for 21years and had been treated with tocilizumab (TCZ) for 3months before this hospitalization. She had few symptoms except loss of appetite for a few days, then oxygen desaturation was detected by pulse oximeter when she visited family doctor to receive annual influenza vaccination. Instead of giving her a vaccination, she was instructed to go to another hospital on the same day to be examined in relation to oxygen desaturation. Marked hypoxemia and diffuse pulmonary lesions by chest X-ray were revealed there, and she was transported to our intensive-care unit. She was intubated immediately, and then severe hypotension occurred. Fluid administration and large doses of catecholamines were needed to maintain her blood pressure. Steroid pulse therapy, antimicrobial agents and sivelestat were used simultaneously. She was intubated for 13days, and was discharged from hospital on foot after 58days of hospitalization. We considered her illness as severe pneumonia with shock based on clinical, laboratory and radiological findings and therapeutic response. However, we were not able to examine the causative microorganisms sufficiently owing to her severe circulatory and respiratory condition. Severe infections with circulatory collapse appear to be a rare but serious complication during treatment with TCZ.
