[Anti-TNF alpha monoclonal antibodies (infliximab) and tuberculosis: apropos of 3 cases].
BACKGROUND
Monoclonal TNF alpha antibodies are a new treatment of severe rheumatoid arthritis. One of the possible side effects is the appearance of opportunistic infections. We report here on three cases of disseminated tuberculosis observed in patients undergoing treatment with infliximab.


METHODS
A 45-year-old woman, treated with infliximab, was hospitalised after five infusions for fever and dyspnoea. The exams showed pulmonary and peritoneal tuberculosis. The second case is a 75-year-old woman whose symptoms were fever, cough and cervical adenopathy after three infliximab infusions. Diagnosis was disseminated tuberculosis. The third case is a 59-year-old man who was hospitalised for an infectious syndrome with dyspnoea, after two infliximab infusions. We discovered pulmonary tuberculosis.


CONCLUSIONS
These three cases added to the 68 cases of tuberculosis registered with the treatment of infliximab. This confirms the risk of severe opportunist infectious side effects. TNF alpha is a cytokine which has anti-infectious properties. These tuberculoses are severe and generalized. It is recommended to search for an active or latent tuberculosis before beginning treatment with infliximab, and to check these patients frequently.
Roth
S
S
Service de médecine interne I, hôpital de l'Archet 1, CHU, 151, route de Saint-Antoine de Ginestière, BP 3079, 06202 Nice, France.
Delmont
E
E
Heudier
P
P
Kaphan
R
R
Cua
E
E
Castela
J
J
Verdier
J M
JM
Chichmanian
R M
RM
Fuzibet
J G
JG
D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects*; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D005260:Female; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D010532:Peritoneal Diseases / Q000209:etiology; D013997:Time Factors; D014376:Tuberculosis / Q000209:etiology*; D014385:Tuberculosis, Gastrointestinal / Q000209:etiology; D014391:Tuberculosis, Miliary / Q000209:etiology; D014397:Tuberculosis, Pulmonary / Q000209:etiology
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D000069285:Infliximab
Anticorps anti-TNF alpha (infliximab) et tuberculose: à propos de trois cas.