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Cat scratch disease during etanercept therapy.

Sylvain Mathieu1, Jean-François Vellin, David Poujol

  • 1Clermont-Ferrand Teaching Hospital, Rheumatology Department, G. Montpied Hospital, Clermont-Ferrand, France. smathieu11@yahoo.fr <smathieu11@yahoo.fr>

Joint Bone Spine
|March 6, 2007
PubMed
Summary

Enlarged lymph nodes in patients on TNFalpha antagonist therapy can signal tuberculosis or cancer. This case highlights Bartonella henselae as a cause of granulomatous lymphadenopathy in patients receiving etanercept for ankylosing spondylitis.

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Area of Science:

  • Immunology
  • Infectious Diseases
  • Rheumatology

Background:

  • Tumor necrosis factor-alpha (TNFα) antagonists are used to treat inflammatory conditions like ankylosing spondylitis.
  • Lymphadenopathy in patients on TNFα antagonist therapy raises concerns for infections (e.g., tuberculosis) or hematological malignancies.
  • Granulomatous inflammation in lymph nodes can be indicative of various infectious agents.

Observation:

  • A patient with ankylosing spondylitis developed lymphadenopathy while undergoing treatment with etanercept, a TNFα antagonist.
  • Histological examination of the lymph node revealed granulomatous inflammation.

Findings:

  • The granulomatous lymphadenopathy was diagnosed as Bartonella henselae infection.
  • This finding is significant as Bartonella henselae is not a commonly recognized cause of granulomatous lymphadenopathy in patients on TNFα antagonist therapy.

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Implications:

  • This case expands the differential diagnosis of granulomatous lymphadenopathy in patients receiving TNFα antagonist therapy.
  • It underscores the importance of considering atypical infections, such as Bartonella henselae, in immunocompromised patients presenting with lymphadenopathy.
  • Clinicians should maintain a high index of suspicion for infectious etiologies beyond tuberculosis when granulomatous reactions are observed.