Viral Pneumonia as a Serious Complication of Etanercept Therapy

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Abstract
TO THE EDITOR: Levels of tumor necrosis factor are elevated in the synovial fluid of patients with rheumatoid arthritis. Etanercept in- hibits tumor necrosis factor and is an effective treatment for rheu- matoid arthritis (1, 2). Tumor necrosis factor is also integral to the immune response to many pathogens, including respiratory viruses (3). We report a case of severe parainfluenza pneumonia in a patient taking etanercept. A 54-year-old woman with severe rheumatoid arthritis pre- sented with 10 days of dyspnea, pharyngitis, and headache. Exami- nation revealed mild respiratory distress, fever (body temperature, 83 °C), and evidence of chronic rheumatoid arthritis and long-term steroid use. She had diffuse rales and a moderate holosystolic mur- mur (she had known aortic insufficiency). The leukocyte count was 5.1 109 cells/L, and studies of arterial blood revealed a pH of 7.45, PCO2 of 35 mm Hg, and PO2 of 68 mm Hg. Chest radiography showed a diffuse reticulonodular pulmonary pattern. The patient was hospitalized, and erythromycin and ceftriaxone were empirically ad-