title: Oral tuberculosis associated with a treatment with anti-rheumatic drugs.
abstract: BACKGROUND
  The use of immunosuppressive medication is a dominant risk factor for infection in patients with rheumatoid arthritis (RA). Methotrexate (MTX) is one of the traditional disease-modifying antirheumatic drugs. Adalimumab [a human anti-tumor necrosis factor-alpha (anti-TNF-alpha) monoclonal antibody] represent an important advance in the treatment of RA and has been recently come in use. TNF-alpha plays a role in the host defense against Mycobacterium tuberculosis and notably in granuloma formation. Infections occur at a high rate among those who use one or the combination of the two medications.
  
  
  METHODS
  We examined a female patient that was referred to our department for evaluation and treatment of a granular lesion on the soft palate and uvula, complaining of mild dysphagia. The patient was treated for 4 months with MTX and adalimumab for RA before the oral lesion appeared.
  
  
  RESULTS
  The histopathological examination of a specimen of the oral lesion, taken by biopsy, showed a chronic inflammation characterized by tuberculous granulomas. Polymerase chain reaction test and culture of a new specimen was positive for M. tuberculosis.
  
  
  CONCLUSIONS
  The therapeutic use of MTX or/and adalimumab for the treatment of RA or few others diseases, can cause oral tuberculosis.
authors.affiliation: Department of Oral Medicine and Maxillofacial Pathology, Dental School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Kolokotronis
authors.forename: Evanda
authors.initials: E
authors.lastname: Avramidou
authors.forename: Thomas
authors.initials: T
authors.lastname: Zaraboukas
authors.forename: Kalliopi
authors.initials: K
authors.lastname: Mandraveli
authors.forename: Stella
authors.initials: S
authors.lastname: Alexiou
authors.forename: Demetrios
authors.initials: D
authors.lastname: Antoniades
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008727:Methotrexate / Q000627:therapeutic use; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D009894:Opportunistic Infections / Q000175:diagnosis; D014375:Tuberculoma / Q000175:diagnosis; D014393:Tuberculosis, Oral / Q000175:diagnosis*; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab; D008727:Methotrexate