Re: infections due to lowered immunity from biologics

April 9, 2009

Judy, I've been on Enbrel for over five years and have not had a

serious infection during that time. I know that I'm lucky, and I'm

very thankful. I do take vitamins and vitamin C and don't know if they

help or not.

I got shingles a couple of months after my RA symptoms started. Since

I hadn't seen a rheumatologist, I hadn't been diagnosed with RA and of

course was not on any RA meds. My PCP treated it aggressively, and I

had very little trouble with it. I think that we're more susceptible

to getting shingles just by having RA, since our immune system has

gone haywire.

I don't know what I'd do in your situation. I guess I would follow my

rheumy's advice.

Good luck, and keep us posted.

Sue

On Apr 9, 2009, at 5:29 PM, judyamcgee wrote:

> We've all read the warnings on our meds. We try to ignore them &

> think that it won't happen to me. We would try anything for relief

> & a chance at a normal life. I am curious, has anyone else had a

> serious infection while on a biologic, & been told it was because of

> lowered immunity, due to medication?

April 10, 2009

Thanks, Sue. I really want to do what the rheumy says, but I'm really having

second thoughts abou this. Now that it's happened to me twice in 5 months.

I've been on the antibiotic & anti-fungal med for 4 days, & it seems to be

slowly getting better. I was so startled when he mentioned hospital that I did

not ask any questions. I just wanted out of there to get the prescriptions

filled! Thanks for your concern, & I'll keep you all posted.

Judy

> We've all read the warnings on our meds. We try to ignore them &

> think that it won't happen to me. We would try anything for relief

> & a chance at a normal life. I am curious, has anyone else had a

> serious infection while on a biologic, & been told it was because of

> lowered immunity, due to medication?

April 16, 2009

I received my biopsy results today. I was told it is pustular folliculitis. I

don't understand this. The lab tech said it was infected hair follicles. Makes

no sense to me as usually the first place that breaks out is on the palm of my

hands and it was all over my face and neck this time. So frustrating!

I'm still fighting bronchitis. I've been having trouble keeping my breath when

I'm active or talk too much but the doctor says he can't find anything wrong

other than I'm still recovering from bronchitis.

I just don't understand this rash. It happens every time right before I get

sick. I'm on Enbrel, MTX, Celebrex as well as other non-RA meds for other

things.

Phyllis

___________________________________________________

I have noticed in the last year that when my system is weakened, I will break

out in little blister/boil looking bumps. Very small, like a pencil point. They

itch while they are coming to the surface of my skin but then quit, scab over

and go away. A day or two later, I will get sick. Usually strep throat or

bronchitis. This time, it's bronchitis.

April 16, 2009

I found this article. Do these symptoms possible sound like yours? Hope this

helps.

Eosinophilic pustular folliculitis

General InformationSymptoms and CausesPrevention and TreatmentReferences

CAUSES

The causes of all three types of EPF remain unknown. Some researchers suggest

that the condition is caused by an allergic reaction to dermatophytes (parasitic

fungi that cause skin infections) or saprophytic fungi (fungi that live on

decaying or decomposing organic matter), such as Pityrosporum ovale.This theory

is supported by the positive therapeutic response of some patients to oral

therapy with itraconazole (antifungal drug). Also, bacteria similar to

Leptotrichia buccalis were found in one biopsy specimen of a patient with

HIV-associated EPF. The disease responded to oral metronidazole (antibiotic used

to treat bacterial infections).

Some researchers speculate that overgrowth of Malassezia or Demodex (the hair

follicle mite) might be involved in the development of EPF.

Another theory is that HIV-associated EPF is an autoimmune disorder that causes

eosinophils (type of white blood cells that help fight against disease and

infection) to mistakenly attack the sebum (oils produced in the skin).

SYMPTOMS

The symptoms for all three variants of the disease are generally the same. About

20% of patients suffer from reddish bumps and/or pimples on the hands or feet,

which may be the first signs of the disease.

Patients experience dandruff or dry, scaly skin on the head and trunk of the

body. Papulopustules (white-headed pimples that are filled with pus) usually

appear around hair follicles on the face and trunk, although the extremities

(arms and legs) may also be involved. The classic form tends to affect the palms

and soles of the feet. In children, the scalp is more frequently involved.

Individual papulopustules may be larger in the classic form (up to 20 to 50mm in

diameter) than the HIV-associated or infantile form, which are typically about

one to three millimeters in diameter.

The infection may itch or be tender. However, the classic variant of the disease

is typically less itchy than the other two forms.

Uncommon symptoms, including nonfolilcular papules (small lesions on the skin

that are not near hair follicles) and hives are often seen in infants and HIV

patients.

DIAGNOSIS

Skin biopsy: A skin biopsy is the standard diagnostic test for eosinophilic

pustular folliculitis (EPF). During the procedure, a local anesthetic may be

applied to numb the skin that will be sampled. The healthcare provider will then

use a scalpel to either cut out or shave off a small sample of skin. The sample

is then analyzed under a microscope. Skin biopsies reveal lymphocytic and

eosinophilic inflammation around the hair follicles.

Complete blood count: During a complete blood count, a small sample of blood is

taken from the patient and analyzed under a microscope in a laboratory. A

complete blood count is not considered a diagnostic test for EPF. However, a

blood test may detect an increased number of eosinophils in the blood, which may

indicate EPF. Eosinophils make up about one to three percent of a healthy

person's white blood cells, which is about 350 to 650 eosinophils per microliter

of blood.

http://www.wellness.com/reference/allergies/eosinophilic-pustular-folliculitis/s\

ymptoms-and-causes

>

> I received my biopsy results today. I was told it is pustular folliculitis.

I don't understand this. The lab tech said it was infected hair follicles.

Makes no sense to me as usually the first place that breaks out is on the palm

of my hands and it was all over my face and neck this time. So frustrating!

>

> I'm still fighting bronchitis. I've been having trouble keeping my breath

when I'm active or talk too much but the doctor says he can't find anything

wrong other than I'm still recovering from bronchitis.

>

> I just don't understand this rash. It happens every time right before I get

sick. I'm on Enbrel, MTX, Celebrex as well as other non-RA meds for other

things.

>

> Phyllis

> ___________________________________________________

> I have noticed in the last year that when my system is weakened, I will break

out in little blister/boil looking bumps. Very small, like a pencil point. They

itch while they are coming to the surface of my skin but then quit, scab over

and go away. A day or two later, I will get sick. Usually strep throat or

bronchitis. This time, it's bronchitis.

>

April 17, 2009

Wow, Phyllis - I'm sorry you weren't given a more definitive diagnosis than

pustular folliculitis. Did they have any recommendations on how to get rid of

it? Or how to prevent it from coming back in the future? Have you tried a

cortisone cream?

As for your lungs, they worry me. Has anyone done a chest x-ray? Perhaps you

should see a pulmonologist and have a complete pulmonary evaluation done (PFT).

I would think that would give them a clearer picture of what is going on.

Hang in there. Feel better soon.....Doreen

I received my biopsy results today. I was told it is pustular folliculitis. I

don't understand this. The lab tech said it was infected hair follicles. Makes

no sense to me as usually the first place that breaks out is on the palm of my

hands and it was all over my face and neck this time. So frustrating!

I'm still fighting bronchitis. I've been having trouble keeping my breath

when I'm active or talk too much but the doctor says he can't find anything

wrong other than I'm still recovering from bronchitis.

I just don't understand this rash. It happens every time right before I get

sick. I'm on Enbrel, MTX, Celebrex as well as other non-RA meds for other

things.

Phyllis

April 17, 2009

if it's caused by fungus then a course of anti-fungals coudl resolve it.

biologics do bring on fungal infections by lowering immunity so the

enbrel coudl be causing this.

monique

I found this article. Do these symptoms possible sound like yours? Hope

this helps.

Eosinophilic pustular folliculitis

General InformationSymptoms and CausesPrevention and TreatmentReferences

CAUSES

The causes of all three types of EPF remain unknown. Some researchers

suggest that the condition is caused by an allergic reaction to

dermatophytes (parasitic fungi that cause skin infections) or

saprophytic fungi (fungi that live on decaying or decomposing organic

matter), such as Pityrosporum ovale.This theory is supported by the

positive therapeutic response of some patients to oral therapy with

itraconazole (antifungal drug). Also, bacteria similar to Leptotrichia

buccalis were found in one biopsy specimen of a patient with

HIV-associated EPF. The disease responded to oral metronidazole

(antibiotic used to treat bacterial infections).

Some researchers speculate that overgrowth of Malassezia or Demodex (the

hair follicle mite) might be involved in the development of EPF.

Another theory is that HIV-associated EPF is an autoimmune disorder that

causes eosinophils (type of white blood cells that help fight against

disease and infection) to mistakenly attack the sebum (oils produced in

the skin).

SYMPTOMS

The symptoms for all three variants of the disease are generally the

same. About 20% of patients suffer from reddish bumps and/or pimples on

the hands or feet, which may be the first signs of the disease.

Patients experience dandruff or dry, scaly skin on the head and trunk of

the body. Papulopustules (white-headed pimples that are filled with pus)

usually appear around hair follicles on the face and trunk, although the

extremities (arms and legs) may also be involved. The classic form tends

to affect the palms and soles of the feet. In children, the scalp is

more frequently involved. Individual papulopustules may be larger in the

classic form (up to 20 to 50mm in diameter) than the HIV-associated or

infantile form, which are typically about one to three millimeters in

diameter.

The infection may itch or be tender. However, the classic variant of the

disease is typically less itchy than the other two forms.

Uncommon symptoms, including nonfolilcular papules (small lesions on the

skin that are not near hair follicles) and hives are often seen in

infants and HIV patients.

DIAGNOSIS

Skin biopsy: A skin biopsy is the standard diagnostic test for

eosinophilic pustular folliculitis (EPF). During the procedure, a local

anesthetic may be applied to numb the skin that will be sampled. The

healthcare provider will then use a scalpel to either cut out or shave

off a small sample of skin. The sample is then analyzed under a

microscope. Skin biopsies reveal lymphocytic and eosinophilic

inflammation around the hair follicles.

Complete blood count: During a complete blood count, a small sample of

blood is taken from the patient and analyzed under a microscope in a

laboratory. A complete blood count is not considered a diagnostic test

for EPF. However, a blood test may detect an increased number of

eosinophils in the blood, which may indicate EPF. Eosinophils make up

about one to three percent of a healthy person's white blood cells,

which is about 350 to 650 eosinophils per microliter of blood.

http://www.wellness.com/reference/allergies/eosinophilic-pustular-folliculitis/s\

ymptoms-and-causes

<http://www.wellness.com/reference/allergies/eosinophilic-pustular-folliculitis/\

symptoms-and-causes>

April 20, 2009

Thank you! It does sound very much like what I have. I have an appt. with the

rheumy tomorrow and will take the test results with me. Thank you for taking

time to send this to me!

Phyllis

[ ] Re: infections due to lowered immunity from biologics