TNF and bacterial infectious disease with sepsis: In children with JIA treated with multiple DMARDs alongside anti–TNF-α biologicals, a systematic review from 2013 reported 4 deaths, 3 of which were associated with severe infections: 2 treated with etanercept (group A Streptococcus–related purpura fulminans) and 1 with adalimumab (bacterial sepsis); for 1 treated with infliximab, infection cause was not given (27).