title: Tonsillar tuberculosis in a rheumatoid arthritis patient receiving anti-TNFalpha (adalimumab) treatment.
abstract: This case report describes a 61-year-old rheumatoid arthritis patient with an atypical clinical presentation of a sore throat. Because of rheumatoid arthritis refractory to conventional disease-modifying antirheumatic drug therapy, anti-TNFalpha was felt to be indicated, and a screening for tuberculosis was carried out. As the screening for tuberculosis (PPD) was positive, isoniazid was prescribed prophylactically for six months. After eight months of anti-TNFalpha (adalimumab) treatment, he developed tonsillar enlargement and nodular pulmonary lesions. Histopathological and microbial investigations established the diagnosis of tonsillar tuberculosis.
authors.affiliation: Department of Rheumatology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands.
authors.forename: M N
authors.initials: MN
authors.lastname: Efde
authors.forename: P M
authors.initials: PM
authors.lastname: Houtman
authors.forename: J P L
authors.initials: JP
authors.lastname: Spoorenberg
authors.forename: T L T A
authors.initials: TL
authors.lastname: Jansen
mesh_terms: D000068879:Adalimumab; D000900:Anti-Bacterial Agents; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000995:Antitubercular Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000188:drug therapy*; D004269:DNA, Bacterial / Q000032:analysis; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000235:genetics / Q000302:isolation & purification; D014066:Palatine Tonsil / Q000382:microbiology* / Q000473:pathology; D016133:Polymerase Chain Reaction; D012307:Risk Factors; D014387:Tuberculosis, Laryngeal / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000995:Antitubercular Agents; D004269:DNA, Bacterial; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab