Delayed response to anti-tuberculosis treatment in a patient on infliximab.
The introduction of infliximab, an anti-TNF-alpha agent, in the treatment of rheumatic diseases has offered important therapeutic advances in recent years. The main adverse effect from the usage of this drug is susceptibility to infections, mainly reactivation of latent tuberculosis. We present a 23 year-old male with ankylosing spondylitis, who developed endobronchial and widespread pulmonary tuberculosis, 2 years after initiation of treatment with infliximab. The patient had already been treated for a positive PPD skin test with a 9-month prophylactic course of isoniazid. He was treated with a five drug anti-tuberculosis scheme but he showed an extremely slow therapeutic response with daily high fever, even 4 months after initiation of treatment. Seven months after beginning anti-tuberculosis therapy, bronchoscopy still revealed necrotic and inflammatory tissue at the site of the original lesions. This unusual clinical course of tuberculosis infection was attributed to immunosuppression due to the long-lasting anti-TNF-alpha action of infliximab.
Vlachaki
Elina
E
Department of Pneumonology, Army General Hospital of Athens, Gyzi, 11474 Athens, Greece.
Psathakis
Kostas
K
Tsintiris
Kostas
K
Iliopoulos
Alexios
A
D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use*; D004347:Drug Interactions; D006801:Humans; D000069285:Infliximab; D007538:Isoniazid / Q000627:therapeutic use*; D008297:Male; D013167:Spondylitis, Ankylosing / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology; D013997:Time Factors; D017211:Treatment Failure; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors / Q000276:immunology
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D000995:Antitubercular Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D007538:Isoniazid