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Unexpected outcome (positive or negative) including adverse drug reactions
A case of severe staphylococcal septicaemia: septic arthritis and a mediastinal abscess following leflunamide therapy for rheumatoid arthritis
  1. Anjali Balasanthiran1,
  2. Tannaz Vakilgilani2,
  3. Ken Darzy3,
  4. Jeremy Axon4
  1. 1Specialist Registrar in Diabetes and Endocrinology, Lister Hospital, Coreys Mill Lane, Stevenage, Hertfordshire, UK
  2. 2ST3 in Diabetes and Endocrinology, East and North Herts NHS Trust, Queen Elizabeth 2nd Hospital, Howlands, Welwyn Garden City, Hertfordshire, UK
  3. 3Consultant Diabetes and Endocrinology, Queen Elizabeth 2nd Hospital, Howlands, Welwyn Garden City, Hertfordshire, UK
  4. 4Consultant Rheumatologist, Queen Elizabeth 2nd Hospital, Howlands, Welwyn Garden City, Hertfordshire, UK
  1. Correspondence to Anjali Balasanthiran, ABala75{at}hotmail.com

Summary

This highly unusual case illustrates how a potentially life-threatening complication may develop insidiously in the context of immunosuppression.

A 46-year-old woman presented with increasing malaise and a marked inflammatory response in the context of immunosuppressive therapy for rhueumatoid arthritis. On the basis of microbiological findings, the patient was treated for systemic staphylococcal infection with a prolonged antibiotic course. In addition, incision and drainage procedures were performed on associated, non-resolving abscesses at various sites. One particular lesion in the breast was slow to heal and was monitored with ultrasound imaging. Subsequent cross-sectional imaging revealed that this was, in fact, a large mediastinal abscess, eroding the manubrium and lying within close proximity of the aorta. The patient was eventually referred to a cardiothoracic unit for complete evacuation of this lesion. Following a prolonged illness and treatment period, the patient recovered well and successfully resumed employment.

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Footnotes

  • Competing interests None.

  • Patient consent Obtained.

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