title: Pulmonary miliary tuberculosis in a patient with anti-TNF-alpha treatment.
abstract: No difference in the number of serious adverse events was reported in previous clinical trials in rheumatoid arthritis (RA) and inflammatory bowel disease (IBD) patients treated with TNF-alpha blockade, but a patient died because of disseminated tuberculosis. A tuberculosis reactivation in a patient with IBD and anti-TNF-alpha treatment has been recently reported. Very recently 70 cases of tuberculosis were reported from the FDA Adverse Event Reporting System. We report a case of pulmonary miliary tuberculosis in a RA patient treated with TNF-alpha blockade. The important role of TNF-alpha in defence against tuberculosis and possible mechanisms of anti-TNF-alpha agents impairing tuberculosis immune response are discussed.
authors.affiliation: Rheumatology Unit, Hospital Universitario Valme, Seville, Spain. lmayordomo@wanadoo.es
authors.forename: Lucia
authors.initials: L
authors.lastname: Mayordomo
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Marenco
authors.forename: Jesus
authors.initials: J
authors.lastname: Gomez-Mateos
authors.forename: Eduardo
authors.initials: E
authors.lastname: Rejon
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000276:immunology; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D000069285:Infliximab; D008168:Lung / Q000000981:diagnostic imaging; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D014057:Tomography, X-Ray Computed; D014391:Tuberculosis, Miliary / Q000139:chemically induced* / Q000276:immunology / Q000473:pathology; D014397:Tuberculosis, Pulmonary / Q000139:chemically induced* / Q000276:immunology / Q000473:pathology; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology*
chemical_list: D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab