Fatal sepsis in a patient with rheumatoid arthritis treated with etanercept

Patients with long-standing, severe, erosive rheumatoid arthritis who have extra-articular manifestations and have undergone joint replacement surgery are at increased risk for serious infection and premature mortality. New t herapies, including cytokine antagonists, hold great promise for improving the course of rheumatoid arthritis, However, they have powerful anti-inflam matory effects that may mask symptoms of serious infection. We report a cas e of fatal pneumococcal sepsis occurring in a 37-year-old woman with rheuma toid arthritis treated with the tumor necrosis factor antagonist etanercept and suggest management strategies for early detection and management of th is complication.