Acute appendicitis in a rheumatoid arthritis patient treated with tocilizumab: report of a case

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  • Maruya Yasuhiro
    Department of Surgery, Nagasaki Prefecture Shimabara Hospital Departmaent of Surgery, Nagasaki University Graduate School of Biomedical Sciences
  • Taniguchi Ken
    Department of Surgery, Nagasaki Prefecture Shimabara Hospital
  • Koga Naoki
    Department of Surgery, Nagasaki Prefecture Shimabara Hospital
  • Azuma Takashi
    Department of Surgery, Nagasaki Prefecture Shimabara Hospital
  • Matsuo Shigetoshi
    Department of Surgery, Nagasaki Prefecture Shimabara Hospital
  • Hayashi Tomayoshi
    Department of Pathology, Nagasaki University Hospital
  • Eguchi Susumu
    Departmaent of Surgery, Nagasaki University Graduate School of Biomedical Sciences

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A 55-year-old woman had been treated for rheumatoid arthritis with tocilizumab 1 month prior to the onset of mild abdominal pain. Computed tomography revealed swelling of the appendix and ascites around the appendix. She was diagnosed with acute appendicitis and underwent emergency surgery. Although her symptoms and laboratory data indicated mild infection, surgery was conducted because of the computed tomography findings and because we believed that the physical findings and laboratory data were not dependable due to the tocilizumab. 　Upon surgery, a perforated inflamed appendix and abscess formation around the appendix were confirmed. Tocilizumab, which is relatively new, may conceal signs of infection or dull response to tests such as the Blumberg sign for peritonitis. It should be widely noted that the physical findings and laboratory data of patients with abdominal distress under tocilizumab treatment may be misleading.

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