These cases illustrate a number of important points of relevance to acute and general medical physicians as well as in specialties such as Rheumatology. Firstly, patients who are on anti-IL-6 medications may present in a different and less florid way when infected systemically with Staphylococcus aureus than immunocompetent patients. Secondly, they provide a reminder to doctors to ask about any injected therapies that the patient may have received in the last 6 months when taking a drug history. Thirdly, they give a warning to prescribers of drugs such as tocilizumab that such bacterial dissemination can occur, and to be particularly wary in the presence of likely risk factors, such as indwelling prosthetic material or previous invasive disease caused by Staphylococcus aureus.
Dr Thomas C Morris
NHS – Infectious Diseases