| Abstract | BACKGROUND: A 63-year-old German woman with a 24-year history of Crohn's disease and associated polyarthralgias presented with severe malaise, dyspnea, fever, night sweats, dry cough and an extensive right-sided pleural effusion. The patient had begun treatment with bi-weekly subcutaneous injections of adalimumab 5 weeks earlier. INVESTIGATIONS: Physical examination, chest X-ray, transthoracic ultrasonography, pleural tap and drainage, bacterial and cytological analyses of pleural fluid, bronchoscopy, microscopy and bacteriological culture of pleural exudates and bronchoalveolar lavage fluid, thoracic CT, thoracoscopy, histopathology of pleural biopsy, tuberculin skin test, nucleic acid amplification of mycobacterial RNA and DNA in the pleural fluid specimens and the parietal pleural biopsy, microscopy of sputum samples, ESAT-6-specific and CFP-10-specific interferon-gamma enzyme-linked immunospot assay on peripheral blood and pleural exudate mononuclear cells. DIAGNOSIS: Pulmonary and pleural tuberculosis. MANAGEMENT: Cessation of adalimumab treatment. Initiation of quadruple antibiotic therapy with isoniazid, rifampin, ethambutol and pyrazinamide. Prednisolone administered to reduce the pleural effusion. |
| Authors | Christoph Lange, Bernhard Hellmich, Martin Ernst, Stefan Ehlers
(Affiliation: Medical Clinic, and Division of Clinical Infectious Diseases, Research Center Borstel, Germany.)
|
| Journal | Nature clinical practice. Rheumatology
(Nat Clin Pract Rheumatol)
Vol. 3
Issue 9
Pg. 528-34
(Sep 2007)
ISSN: 1745-8382 United States |
| PMID | 17762852
(Publication Type: Case Reports, Journal Article)
|
| Chemical References |
- Anti-Inflammatory Agents
- Antibodies, Monoclonal
- adalimumab
- Interferon Type II
|
| Topics |
- Anti-Inflammatory Agents
(adverse effects)
- Antibodies, Monoclonal
(adverse effects)
- Arthralgia
(complications)
- Crohn Disease
(complications)
- Female
- Humans
- Immunoenzyme Techniques
- Interferon Type II
(analysis)
- Middle Aged
- T-Lymphocytes
(metabolism)
- Tuberculosis, Pleural
(chemically induced, diagnosis)
- Tuberculosis, Pulmonary
(chemically induced, diagnosis)
|
