{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T15:57:55Z","timestamp":1792252675194,"version":"4.4.0"},"reference-count":8,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"abstract":"<jats:p>This is a case of a 65-year-old man with seropositive erosive rheumatoid arthritis (RA), well controlled on methotrexate, sulfasalazine, low-dose prednisolone and monthly infusions of tocilizumab. He presented with a 3-week history of pain and swelling in his left knee, gradually increasing in severity with an inability to bear weight . He was systemically well with normal vital signs. Examination confirmed an effusion and aspiration was turbid in appearance. C reactive protein (CRP) was normal. He was treated empirically with antibiotics. Synovial fluid and blood cultures confirmed<jats:italic>Staphylococcus aureus<\/jats:italic>infection. He completed a 6\u2005weeks course of antibiotics with complete resolution of symptoms. Throughout the treatment his CRP remained normal which is likely to have been the result of prior treatment with tocilizumab.<\/jats:p>","DOI":"10.1136\/bcr-2013-010423","type":"journal-article","created":{"date-parts":[[2013,10,31]],"date-time":"2013-10-31T09:44:09Z","timestamp":1383212649000},"page":"bcr2013010423","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":41,"title":["C reactive protein may not be reliable as a marker of severe bacterial infection in patients receiving tocilizumab"],"prefix":"10.1136","volume":"2013","author":[{"given":"Syed Farhan","family":"Bari","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afsha","family":"Khan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Lawson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2013,10,31]]},"reference":[{"key":"2025042709342768000_2013.oct31_1.bcr2013010423.1","unstructured":"NICE technology appraisal guidance (TA 247)."},{"key":"2025042709342768000_2013.oct31_1.bcr2013010423.2","doi-asserted-by":"crossref","first-page":"77","DOI":"10.2174\/157339711794474620","article-title":"Choice of biologic therapy for patients with rheumatoid arthritis: the infection perspective","volume":"2013","author":"Keyser","year":"2011","journal-title":"Current Rheumatol Rev"},{"key":"2025042709342768000_2013.oct31_1.bcr2013010423.3","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1093\/rheumatology\/keg263","article-title":"Serious bacterial infections in patients with rheumatoid arthritis under anti-TNF\u03b1 therapy","volume":"2013","author":"Kroesen","year":"2003","journal-title":"Rheumatology"},{"key":"2025042709342768000_2013.oct31_1.bcr2013010423.4","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1016\/S0749-0704(02)00022-2","article-title":"Infections in the immunocompromised rheumatologic patient","volume":"2013","author":"Greenberg","year":"2002","journal-title":"Crit Care Clin"},{"key":"2025042709342768000_2013.oct31_1.bcr2013010423.5","doi-asserted-by":"crossref","unstructured":"Nguyen M Podenphant J Pernille R . Three cases of severely disseminated Staphylococcus aureus infection in patients treated with tocilizumab. BMJ Case Rep. Published online: 2 Jan 2013. doi: 10.1136\/bcr-2012-007413.","DOI":"10.1136\/bcr-2012-007413"},{"key":"2025042709342768000_2013.oct31_1.bcr2013010423.6","doi-asserted-by":"crossref","unstructured":"Yanagawa Y Hirano Y Kato H . The absence of typical pneumonia symptoms in a patient with rheumatoid arthritis during tocilizumab and steroid treatment. BMJ Case Rep. Published online: 23 May 2012. doi: 10.1136\/bcr.02.2012.5835.","DOI":"10.1136\/bcr.02.2012.5835"},{"key":"2025042709342768000_2013.oct31_1.bcr2013010423.7","doi-asserted-by":"crossref","first-page":"64","DOI":"10.3109\/s10165-008-0111-7","article-title":"Masked early symptoms of pneumonia in patients with rheumatoid arthritis during tocilizumab treatment: a report of two cases","volume":"2013","author":"Fujiwara","year":"2009","journal-title":"Mod Rheumatol"},{"key":"2025042709342768000_2013.oct31_1.bcr2013010423.8","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1093\/rheumatology\/ker223","article-title":"Risk of infections in rheumatoid arthritis patients treated with tocilizumab","volume":"2013","author":"Lang","year":"2012","journal-title":"Rheumatology"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2013-010423","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T16:34:35Z","timestamp":1745771675000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2013-010423"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,10,31]]},"references-count":8,"alternative-id":["10.1136\/bcr-2013-010423"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2013-010423","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,10,31]]}}}