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01.12.2015 | Case report | Ausgabe 1/2015 Open Access

BMC Pulmonary Medicine 1/2015

Successful resumption of tocilizumab for rheumatoid arthritis after resection of a pulmonary Mycobacterium avium complex lesion: a case report

BMC Pulmonary Medicine > Ausgabe 1/2015
Ho Namkoong, Sadatomo Tasaka, Mitsuhiro Akiyama, Kazuma Yagi, Makoto Ishii, Katsuya Suzuki, Mitsutomo Kohno, Naoki Hasegawa, Tsutomu Takeuchi, Tomoko Betsuyaku
Wichtige Hinweise

Competing interests

The authors state that they have no conflict of interests.

Authors’ contributions

HN and ST drafted the manuscript and were responsible for clinical care of the patients. MA, KY, MI, KS, MK, NH, TT, and TB were responsible for clinical care of the patients. All authors read and approved the final manuscript.



Biological agents inhibiting TNF-α and other molecules involved in inflammatory cascade have been increasingly used to treat rheumatoid arthritis (RA). However, it remains controversial whether biological agents can be used safely in a patient with an underlying chronic infectious disease.

Case presentation

A 63-year-old woman who had been treated with tocilizumab (TCZ), anti-interleukin-6 receptor antibody, for RA presented to our outpatient clinic due to hemoptysis. She was diagnosed with pulmonary Mycobacterium avium complex (MAC) infection, and high-resolution computed tomography (HRCT) showed a single cavitary lesion in the right upper lobe. After diagnosis of pulmonary MAC disease, TCZ was discontinued and combination chemotherapy with clarithromycin, rifampicin, ethambutol and amikacin was started for MAC pulmonary disease. Since the lesion was limited in the right upper lobe as a single cavity formation, she underwent right upper lobectomy. As her RA symptoms were deteriorated around the operation, TCZ was resumed. After resumption of TCZ, her RA symptoms improved and a recurrence of pulmonary MAC infection has not been observed for more than 1 year.


This case suggested that TCZ could be safely reintroduced after the resection of a pulmonary MAC lesion. Although the use of biological agents is generally contraindicated in patients with pulmonary MAC disease, especially in those with a fibrocavitary lesion, a multimodality intervention for MAC including both medical and surgical approaches may enable introduction or resumption of biological agents.
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