Listeria-associated arthritis in a patient undergoing etanercept therapy: case report and review of the literature

Abstract

Listeriosis can be a cause of infectious arthritis. Here, we present a case of articular listeriosis in a patient with rheumatoid arthritis receiving treatment with etanercept, a tumor necrosis factor antagonist. We review the literature of articular listeriosis and discuss the role of tumor necrosis factor blockade in precipitating listeriosis.

FIG. 1.

Imaging of the right shoulder. (A) Plain radiograph of the right shoulder shows marked joint effusion but otherwise normal appearance of the bone and joint space. (B and C) Magnetic resonance examination of the right shoulder. Axial GE T1 weighted sequence (B) shows marked effusion of the subdeltoid bursa. After intravenous administration of gadolinium, contrast media enhancement of the diffusely enlarged and thickened synovia (arrows) (C).

FIG. 2.

Listeria infection in 31 patients treated with infliximab and etanercept. The x axis indicates the percentage of total. (A) Type of TNF-α blocker. (B) Indication of TNF-α blocker. (C) Manifestation of Listeria infection. (D) Concomitant medication. Other immunosuppressive drugs include azathioprine and mercaptopurine. Three patients with methotrexate received combination therapy (one each with hydroxychloroquin, mycophenolat mofetil, and cyclosporine A). (E) Outcome of Listeria infection. Note that categories C and D contain overlapping factors.