Oral tuberculosis associated with a treatment with anti-rheumatic drugs.

Abstract

BACKGROUND:

The use of immunosuppressive medication is a dominant risk factor for infection in patients with rheumatoid arthritis (RA). Methotrexate (MTX) is one of the traditional disease-modifying antirheumatic drugs. Adalimumab [a human anti-tumor necrosis factor-alpha (anti-TNF-alpha) monoclonal antibody] represent an important advance in the treatment of RA and has been recently come in use. TNF-alpha plays a role in the host defense against Mycobacterium tuberculosis and notably in granuloma formation. Infections occur at a high rate among those who use one or the combination of the two medications.

METHOD:

We examined a female patient that was referred to our department for evaluation and treatment of a granular lesion on the soft palate and uvula, complaining of mild dysphagia. The patient was treated for 4 months with MTX and adalimumab for RA before the oral lesion appeared.

RESULTS:

The histopathological examination of a specimen of the oral lesion, taken by biopsy, showed a chronic inflammation characterized by tuberculous granulomas. Polymerase chain reaction test and culture of a new specimen was positive for M. tuberculosis.

CONCLUSIONS:

The therapeutic use of MTX or/and adalimumab for the treatment of RA or few others diseases, can cause oral tuberculosis.

• Authors: Alexandros Kolokotronis, Evanda Avramidou, Thomas Zaraboukas, Kalliopi Mandraveli, Stella Alexiou, Demetrios Antoniades
• Journal: Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology (J Oral Pathol Med) Vol. 35 Issue 2 Pg. 123-5 (Feb 2006) ISSN: 0904-2512 [Print] Denmark
• PMID: 16430744 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antibodies, Monoclonal
• Antibodies, Monoclonal, Humanized
• Antirheumatic Agents
• Immunosuppressive Agents
• Tumor Necrosis Factor-alpha
• Adalimumab
• Methotrexate

Topics

• Adalimumab
• Adult
• Antibodies, Monoclonal (therapeutic use)
• Antibodies, Monoclonal, Humanized
• Antirheumatic Agents (therapeutic use)
• Arthritis, Rheumatoid (drug therapy)
• Female
• Humans
• Immunosuppressive Agents (therapeutic use)
• Methotrexate (therapeutic use)
• Mycobacterium tuberculosis (isolation & purification)
• Opportunistic Infections (diagnosis)
• Tuberculoma (diagnosis)
• Tuberculosis, Oral (diagnosis)
• Tumor Necrosis Factor-alpha (immunology)