Abstract
A 69-year-old woman was admitted into our hospital for dyspnea on exertion. She had been treated with methotrexate since the age of 61.Due to inadequate response to methotrexate, she was treated by addition of infliximab or tocilizumab, however, those were stopped due to lack of efficacy and adverse event, respectively. Therefore, the administration of abatacept was started, while methotrexate was continued. Nine months later, she had dyspnea on exertion and a CT scan revealed ground glass shadow in the bilateral lung field, predominantly in the upper lobe. Exclusion of pulmonary infection, such as bacterial, pneumocystis, cytomegalovirus pneumonia, and other pulmonary diseases, diagnosis of interstitial pneumonia was carried out. After high dose of prednisolone was started, she rapidly improved. However, new ground glass shadows in the bilateral upper lung field and the middle lobe were seen on a chest CT scan, one month later. At that time, detection of cytomegalovirus antigenemia and inclusion body of giant cell from bronchoalveolar lavage fluid revealed complication of cytomegalovirus pneumonia. Administration of Gancyclovir resulted in complete recovery. Abatacept is supposed to have less severe adverse reactions based on its post-marketing surveillance in Japan as compared with those of infliximab, etanercept, tocilizumab, or adalimumab, although the patient demographics and the time of each surveillance period ware different. Furthermore, there are only few reports regarding interstitial pneumonia or cytomegalovirus pneumonia after the administration of abatacept. Therefore, this case report suggests that possibility of these complications should be kept in mind when we use abatacept.
