QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Résumé Extracto Full Text PDF Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Articles Ahead of Print [Order Reprint] Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Borrás-Blasco, J. Articles by Abad, F J. Search for Related Content PubMed PubMed Citation Articles by Borrás-Blasco, J. Articles by Abad, F J.

Parapharyngeal Abscess in a Patient Receiving Etanercept

Specialist in Hospital Pharmacy, Pharmacy Service, Hospital de Sagunto, Sagunto, Valencia, Spain

Claudia Nuñez-Cornejo, MD

Specialist in Physical Medicine and Rehabilitation, Rehabilitation Section, Hospital de Sagunto

Antonio Gracia-Perez, MD

Specialist in Rheumatology, Rehabilitation Section, Hospital de Sagunto

J Dolores Rosique-Robles, PharmD PhD

Specialist in Hospital Pharmacy, Pharmacy Service, Hospital de Sagunto

MD Elvira Casterá, PharmD

Specialist in Hospital Pharmacy, Pharmacy Service, Hospital de Sagunto

Enrique Viosca, MD PhD

Specialist in Physical Medicine and Rehabilitation, Rehabilitation Section, Hospital de Sagunto

F Javier Abad, PharmD PhD

Specialist in Hospital Pharmacy, Pharmacy Service, Hospital de Sagunto

Reprints: Dr. Borrás-Blasco, Pharmacy Department, Hospital de Sagunto, Avda Ramon y Cajal s/n., Sagunto 46520 (Valencia) Spain, fax 34 962659428, jborrasb{at}sefh.es

OBJECTIVE: To report a case of parapharyngeal abscess associated with Streptococcus viridans in a patient with rheumatoid arthritis receiving treatment with etanercept.

CASE SUMMARY: A 40-year-old man diagnosed with rheumatoid arthritis had received treatment with nonsteroidal antiinflammatory drugs, methotrexate, and deflazacort. Six months prior to admission, the patient had a Disease Activity Score of 3.4; clinicians decided to start treatment with etanercept. Chest X-rays were normal and the tuberculin skin test was negative. Treatment with etanercept plus methotrexate was started. Three months later, methotrexate was discontinued. Six months after etanercept therapy was started, the patient presented to our emergency department with a swelling of his neck, odynophagia, otalgia, and trismus. The clinical course was consistent with parapharyngeal abscess. Etanercept treatment was suspended. The parapharyngeal abscess was drained and intravenous methylprednisolone, amoxicillin/clavulanic acid, and clindamycin were administered. The parapharyngeal abscess secretion culture was positive for S. viridans and Bacteroides spp. The patient's condition improved with antibiotic therapy; he was discharged 5 days after admission.

DISCUSSION: Tumor necrosis factor- plays an essential role in the immune-mediated response to infection. In our patient, the most possible cause of parapharyngeal abscess was considered to be etanercept because of the temporal relationship between exposure to the drug and onset of symptoms. Etanercept was the only drug administered before the abscess developed. Based on the Naranjo probability scale, an association between etanercept and the adverse reaction could be considered possible.

CONCLUSIONS: Patients initiated on etanercept therapy should be closely monitored for the development of tuberculosis and other infections. During treatment, all febrile or novel illnesses should be evaluated promptly. If clinical evaluation leads to the suspicion of tuberculosis and other infections associated with etanercept, it should be discontinued immediately.

Key Words: etanercept, parapharyngeal abscess

Published Online, January 16, 2007. www.theannals.com, DOI 10.1345/aph.1H407