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Case report
Rapid development of severe acute respiratory distress syndrome after abatacept treatment in a patient with rheumatoid arthritis
  1. Jorge Gower1,
  2. Gonzalo Labarca1,
  3. Daniel Enos2 and
  4. Estefania Nova-Lamperti1
  1. 1Molecular and Translational Immunology Laboratory, Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, Universidad de Concepcion, Concepcion, Chile
  2. 2Internal Medicine, Universidad San Sebastian, Los Angeles, Chile
  1. Correspondence to Dr Gonzalo Labarca; glabarcat{at}


Abatacept is a biological agent that modulates T-cell costimulation by blocking CD28 signalling. This cytotoxic T-lymphocyte-associated antigen-4-Ig fusion protein was approved for treatment of rheumatoid arthritis (RA). However, a few case reports have revealed respiratory failure after abatacept treatment. In this report, we present a patient with RA who developed severe acute respiratory distress syndrome (ARDS) and who passed away 2 months after starting abatacept. A comprehensive analysis including radiology, blood examinations, infectious panel and flow cytometry lymphocyte analysis was done to determine the cause of respiratory failure. Since no infection was detected in this patient, an association between ARDS and abatacept is a strong possibility due to significant adverse reactions to the biological agent. Considering the rapid progression of respiratory failure after abatacept treatment in this report, we suggest that pulmonary function testing and lung structure evaluation be regarded throughout the early stage of treatment of patients with RA.

  • respiratory system
  • unwanted effects / adverse reactions

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  • Contributors JG: data extraction, data synthesis, critical analysis, manuscript redaction and final approval. GL: data synthesis, critical analysis, manuscript redaction and final approval. DE: patient’s care, data conception, critical analysis, manuscript redaction and final approval. EN-L: principal investigator, data acquisition, data synthesis, critical analysis, manuscript redaction and final approval.

  • 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.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.