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.
MeSH terms
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Antibodies, Monoclonal, Humanized / adverse effects*
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Antibodies, Monoclonal, Humanized / therapeutic use
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Arthritis, Juvenile / complications*
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Arthritis, Juvenile / drug therapy
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Chickenpox / blood
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Chickenpox / etiology
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Chickenpox / pathology*
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Child
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Female
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Humans
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Immunosuppressive Agents / adverse effects*
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Immunosuppressive Agents / therapeutic use
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Interleukin-18 / blood
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Macrophage Activation Syndrome / blood
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Macrophage Activation Syndrome / etiology
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Macrophage Activation Syndrome / pathology*
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Male
Substances
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Antibodies, Monoclonal, Humanized
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IL18 protein, human
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Immunosuppressive Agents
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Interleukin-18
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tocilizumab