Abstract
Biologics for rheumatoid arthritis (RA) are new class of drugs that have been used since about 10 years ago. Abatacept is one of the biologics for RA with relatively low risk of infection; however, the long-standing safety of abatacept is not well known. In this paper, we will report an elderly Japanese RA patient with long-standing abatacept and methotrexate therapy became severe empyema by Streptococcus intermedius.
A 72-year-old woman with RA was suffering from severe dyspnea and right chest pain. The disease activity of RA was kept in check by abatacept and methotrexate for about six years. The radiological examination of the chest showed the capsuled pleural effusion on the right chest. A pleural cavity tube was inserted and pus with Streptococcus intermedius was drained. At first, the conservative therapy with antibiotics was performed, but it was ineffective and video-assisted thracolysis was carried out. During the thracolysis, there was a fistula on the right lower lobe and partial thorarectomy was performed. After the procedure, she became well.
As we know, there are no reports about primary empyema during abatacept therapy. Longstanding biologic therapy increases the risk of serious infections and the similar phenomena could be developed in the administration of abatacept. In our case, the empyema was caused by normal bacterial flora and abatacept was thought to relate to the pathogenesis of the empyema. We have to take note that the long-standing abatacept therapy would increase the risk of serious infections and would develop cases like ours.
