| Abstract | In 2005, a 24-year-old man with Crohn disease who had been treated with infliximab for several months was exposed to an individual with smear-positive tuberculosis. Soon after exposure, he complained of malaise, dry cough, and weight loss. Despite normal chest radiograph findings and negative tuberculin skin test results, tuberculosis was considered to be the most likely diagnosis. The results of a whole-blood assay for detection of interferon- gamma production in response to Mycobacterium tuberculosis-specific antigen were positive. Acid-fast staining and polymerase chain reaction of bronchoalveolar lavage fluid samples had negative results, but M. tuberculosis was cultured. After the initiation of 4 antitubercular drugs and the discontinuation of infliximab therapy, the patient developed an immune reconstitution syndrome accompanied by enlarged mediastinal lymph nodes and multiple intrapulmonary miliary lesions. This case of de novo tuberculosis during anti-tumor necrosis factor alpha treatment illustrates the uncharacteristic presentation of the disease and the elusiveness of the diagnosis, as well as the fact that discontinuation of anti-tumor necrosis factor alpha treatment can be accompanied by an immune reconstitution syndrome similar to that observed in human immunodeficiency virus-infected individuals with tuberculosis. |
| Authors | Sandra M Arend, Eliane M S Leyten, Willeke P J Franken, Erik M Huisman, Jaap T van Dissel
(Affiliation: Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands. s.m.arend at lumc.nl)
|
| Journal | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
(Clin Infect Dis)
Vol. 45
Issue 11
Pg. 1470-5
(Dec 1 2007)
ISSN: 1537-6591 United States |
| PMID | 17990230
(Publication Type: Case Reports, Journal Article)
|
| Chemical References |
- Anti-Inflammatory Agents
- Antibodies, Monoclonal
- Antitubercular Agents
- Tumor Necrosis Factor-alpha
- infliximab
|
| Topics |
- Adult
- Anti-Inflammatory Agents
(therapeutic use)
- Antibodies, Monoclonal
(therapeutic use)
- Antitubercular Agents
(therapeutic use)
- Crohn Disease
(drug therapy)
- Humans
- Immune Reconstitution Inflammatory Syndrome
(chemically induced)
- Male
- Tuberculosis, Pulmonary
(diagnosis, drug therapy)
- Tumor Necrosis Factor-alpha
(antagonists & inhibitors)
|
