Primary varicella infection in children with systemic juvenile idiopathic arthritis under tocilizumab therapy

Mod Rheumatol. 2019 May;29(3):558-562. doi: 10.1080/14397595.2016.1254314. Epub 2016 Dec 14.

Abstract

We report the clinical course and outcome of primary varicella infection in six children with systemic juvenile idiopathic arthritis (sJIA) receiving tocilizumab. None had disseminated or fatal varicella infection, but one patient developed macrophage activation syndrome (MAS) and another had an arthritis relapse. All patients had a significant elevation of serum IL-6 levels, and the two children who developed MAS or arthritis relapse showed high serum IL-18 levels, which could cause a sJIA flare-up.

Keywords: IL-6; Macrophage activation syndrome; Systemic juvenile idiopathic arthritis; Tocilizumab; Varicella.

Publication types

  • Case Reports

MeSH terms

  • Antibodies, Monoclonal, Humanized / adverse effects*
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Arthritis, Juvenile / complications*
  • Arthritis, Juvenile / drug therapy
  • Chickenpox / blood
  • Chickenpox / etiology
  • Chickenpox / pathology*
  • Child
  • Female
  • Humans
  • Immunosuppressive Agents / adverse effects*
  • Immunosuppressive Agents / therapeutic use
  • Interleukin-18 / blood
  • Macrophage Activation Syndrome / blood
  • Macrophage Activation Syndrome / etiology
  • Macrophage Activation Syndrome / pathology*
  • Male

Substances

  • Antibodies, Monoclonal, Humanized
  • IL18 protein, human
  • Immunosuppressive Agents
  • Interleukin-18
  • tocilizumab