27. Side Effect of Tocilizumab or Just Sojia-Associated Inflammation: A Case Report of a 10-Year-Old Boy with Multiple Antibiotic Responsive Inflammatory Collections

Abstract

Introduction: We report a case of a 10-year-old boy with systemic onset JIA (soJIA) receiving treatment with s.c. MTX, oral prednisolone and fortnightly tocilizumab who presented with four episodes of abscesses in the distal upper arms within a 5-month period. Aims: We discuss the possible aetiology and available literature. The features of each presentation are documented in Table 1. Method: He remained systemically well but had pain, swelling, erythema and loss of function. His inflammatory markers were normal at each presentation. Quick resolution was seen with antibiotic treatment and there were no signs of soJIA flare. Tocilizumab was made 4-weekly after the third episode. No injections of MTX or infusions of tocilizumab had been given at the site of the abscesses. Results: Serious infection is listed in side effects of tocilizumab. A Medline and Embase search demonstrated no similar abscesses in patients on tocilizumab. Case reports of lung abscesses, localized cellulitis, necrotizing fasciitis and osteomyelitis were found in adults, but no reports in children (Table 1). Conclusion: We cannot be definitive about the aetiology of this case. It may be the first reported case of bacterial infection in a child with soJIA on tocilizumab. Alternatively, the lack of identified organism may suggest that these were inflammatory abcesses associated with active soJIA. However, the rapid response to antibiotics and the lack of clinical findings of soJIA however makes this less likely. Tocilizumab appears to be very effective in the treatment of soJIA, but we are still learning about side effects and complications. (Table Presented).