{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T05:45:59Z","timestamp":1750657559631,"version":"3.40.5"},"reference-count":28,"publisher":"Wiley","license":[{"start":{"date-parts":[[2021,9,7]],"date-time":"2021-09-07T00:00:00Z","timestamp":1630972800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Case Reports in Rheumatology"],"published-print":{"date-parts":[[2021,9,7]]},"abstract":"<jats:p>Recently, treatment for rheumatoid arthritis has dramatically improved but increases the risk of bacterial and opportunistic infections. Herein, we report a fatal case of concurrent disseminated tuberculosis, pneumocystis pneumonia, and septic shock due to pyelonephritis caused by extended-spectrum \u03b2-lactamase-producing Escherichia coli in a patient with rheumatoid arthritis who received methotrexate, glucocorticoid, and tocilizumab. Despite undergoing intensive treatment, the patient developed respiratory failure and died after 7 days of admission. An autopsy indicated that pulmonary tuberculosis were the ultimate causes of death, while pyelonephritis was controlled.<\/jats:p>","DOI":"10.1155\/2021\/7842049","type":"journal-article","created":{"date-parts":[[2021,9,7]],"date-time":"2021-09-07T21:20:07Z","timestamp":1631049607000},"page":"1-6","source":"Crossref","is-referenced-by-count":1,"title":["A Fatal Case of Concurrent Disseminated Tuberculosis, Pneumocystis Pneumonia, and Bacterial Septic Shock in a Patient with Rheumatoid Arthritis Receiving Methotrexate, Glucocorticoid, and Tocilizumab: An Autopsy Report"],"prefix":"10.1155","volume":"2021","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8651-4149","authenticated-orcid":true,"given":"Shin-Ichiro","family":"Ohmura","sequence":"first","affiliation":[{"name":"Department of Rheumatology, Seirei Hamamatsu General Hospital, Shizuoka, Hamamatsu, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryuhei","family":"Ishihara","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Seirei Hamamatsu General Hospital, Shizuoka, Hamamatsu, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayaka","family":"Mitsui","sequence":"additional","affiliation":[{"name":"Department of Pathology, Seirei Hamamatsu General Hospital, Shizuoka, Hamamatsu, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshiro","family":"Otsuki","sequence":"additional","affiliation":[{"name":"Department of Pathology, Seirei Hamamatsu General Hospital, Shizuoka, Hamamatsu, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshiaki","family":"Miyamoto","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Seirei Hamamatsu General Hospital, Shizuoka, Hamamatsu, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","reference":[{"key":"1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2007.072967"},{"key":"2","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.080791"},{"key":"3","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2011.151092"},{"issue":"3","key":"4","first-page":"387","article-title":"The risk of hospitalized infection in patients with rheumatoid arthritis","volume":"35","author":"A. L. Smitten","year":"2008","journal-title":"Journal of Rheumatology"},{"key":"5","article-title":"Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the centers for disease control and prevention, the national institutes of health, and the HIV medicine association of the infectious diseases society of America","volume":"58","author":"J. E. Kaplan","year":"2009","journal-title":"Morbidity and Mortality Weekly Report"},{"key":"6","doi-asserted-by":"publisher","DOI":"10.3918\/jsicm.21.607"},{"key":"7","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.0287"},{"key":"8","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.5669.PMID:22797452"},{"key":"9","doi-asserted-by":"publisher","DOI":"10.1378\/chest.06-2100"},{"key":"10","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e318232da5e"},{"key":"11","doi-asserted-by":"publisher","DOI":"10.5812\/jjm.17254"},{"issue":"4","key":"12","first-page":"369","article-title":"Concurrent infection of pneumocystis pneumonia and pulmonary tuberculosis in an HIV-seronegative patient","volume":"50","author":"A. K. Janmeja","year":"2008","journal-title":"Indian Journal of Chest Diseases and Allied Sciences"},{"key":"13","doi-asserted-by":"publisher","DOI":"10.1002\/art.10529"},{"key":"14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2014.12.018"},{"key":"15","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.48.1432"},{"key":"16","doi-asserted-by":"publisher","DOI":"10.1016\/j.resinv.2017.01.002"},{"key":"17","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc070728"},{"key":"18","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199212243272603"},{"key":"19","doi-asserted-by":"publisher","DOI":"10.7326\/M20-1594"},{"key":"20","doi-asserted-by":"publisher","DOI":"10.1097\/00005792-199611000-00001"},{"key":"21","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfx014"},{"edition":"2nd","volume-title":"Clinical Guidelines for Immunoglobulin Use","year":"2011","key":"22"},{"key":"23","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61704-9"},{"key":"24","doi-asserted-by":"publisher","DOI":"10.1002\/art.21568"},{"key":"25","doi-asserted-by":"publisher","DOI":"10.1002\/art.39399"},{"key":"26","doi-asserted-by":"publisher","DOI":"10.1007\/s10165-009-0243-4"},{"key":"27","doi-asserted-by":"publisher","DOI":"10.3109\/s10165-008-0111-7"},{"key":"28","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kez349"}],"container-title":["Case Reports in Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/downloads.hindawi.com\/journals\/crirh\/2021\/7842049.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/downloads.hindawi.com\/journals\/crirh\/2021\/7842049.xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/downloads.hindawi.com\/journals\/crirh\/2021\/7842049.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,7]],"date-time":"2021-09-07T21:20:14Z","timestamp":1631049614000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.hindawi.com\/journals\/crirh\/2021\/7842049\/"}},"subtitle":[],"editor":[{"given":"Tsai Ching","family":"Hsu","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,9,7]]},"references-count":28,"alternative-id":["7842049","7842049"],"URL":"https:\/\/doi.org\/10.1155\/2021\/7842049","relation":{},"ISSN":["2090-6897","2090-6889"],"issn-type":[{"type":"electronic","value":"2090-6897"},{"type":"print","value":"2090-6889"}],"subject":[],"published":{"date-parts":[[2021,9,7]]}}}