A 42-year-old woman with a background of psoriatic arthritis presented with a 7-day medical history of fevers of unknown source; she had recently undergone elective shoulder arthroscopy, and her medications included anti-interleukin 17A (anti-IL-17A) drug, secukinumab.
She went on to develop sepsis-induced cardiomyopathy, requiring veno-arterial extracorporeal membrane oxygenation (ECMO), from which she was successfully weaned after 12 days. However, she then went on to develop a candidaemia, with new intra-abdominal collections found incidentally on CT; despite appropriate anti-fungal therapy and attempts at drainage, she passed away.
Both anti-IL-17A treatment and ECMO have been shown to be significant independent risk factors for Candida infection. The use of monoclonal antibody therapy in the management of autoimmune disease, and the use of ECMO in the intensive care setting are each becoming increasingly widespread. Fungal infection should be screened for early in this critically unwell group of patients, and treatment initiated as indicated.
- infectious diseases
- adult intensive care
- drugs: musculoskeletal and joint diseases
- biological agents
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Contributors TF was the main contributing author, including literature review and drafting the work. ZD made a significant contribution through acquisition of microbiological data, drafting the work and critically reviewing it. SS played a key role in devising the concept, providing and analysing the critical care perspective of the report and its final editing.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Patient consent for publication Next of kin consent obtained.
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