Neck mass in a rheumatoid arthritis patient taking etanercept

A 60-year-old Caucasian woman with a history of rheumatoid arthritis and a remote history of a post-traumatic splenectomy developed a serious head and neck infection 11 weeks after beginning therapy with etanercept. The patient required incision and drainage of a neck abscess and 2 weeks of i.v. antibiotics to achieve complete recovery. Her etanercept was also discontinued. The causative organism was Streptococcus constellatus, which is a member of the group of encapsulated organisms known as S. intermedius. A normal functioning spleen as well as tumor necrosis factor are both necessary to ward off encapsulated bacteria. Patients who have had a splenectomy and are then started with etanercept may be especially prone to infections with encapsulated organisms, such as streptococcus.