The prognosis of non-small cell lung cancer (NSCLC) patients with malignant pleural effusion (MPE) due to pleural carcinomatosis is said to be poor. Several reports discussed that the anti-VEGF antibody had the effect of decreasing vascular permeability and reducing pleural effusion. Ramucirumab (RAM), a VEGFR-2 antibody that inhibits tumor angiogenesis, is widely used with docetaxel (DTX) after failure of platinum doublet chemotherapy. Presently, there is no data concerning the tolerable safety profile and efficacy of administering RAM+DTX to patients with NSCLC with MPE.
A 35-year-old non-HIV patient developed pulmonary cryptococcosis after the initiation of infliximab. He recovered by fluconazole treatment and completed the therapy for a total of 6 months. However, he experienced a relapse 16 months later during retreatment with infliximab, revealing an interesting clinical course contradicting retreatment. This case also represents the first case of relapsed pulmonary cryptococcosis suspected during treatment with a biologic agent. Both of these aspects generated important clinical questions about the length of pulmonary cryptococcosis treatment and the necessity of introducing a second prophylaxis for such patients.
Streptococcal toxic shock syndrome caused by group B streptococcus (GBS) is a rare, but lethal disease. We experienced a 45-year-old woman with pustular psoriasis who developed toxic shock-like syndrome during infliximab treatment. Surprisingly, similar episodes recurred three times in one year with restarting of infliximab treatments. In the third episode, GBS were detected in blood, urine, and vaginal secretion cultures. These episodes of shock syndrome were possibly due to GBS. To the best of our knowledge, this is the first case report of recurrent streptococcal toxic shock syndrome possibly caused by GBS which was induced by anti-TNF-α inhibitor therapy. The restarting of biological agents in patients with a history of toxic shock syndrome should therefore be avoided as much as possible.
