title: Reactivation of pulmonary tuberculosis in a patient with rheumatoid arthritis during treatment with IL-1 receptor antagonists (anakinra).
abstract: This single case report describes reactivation of previous pulmonary tuberculosis (TBC) after 23 months of treatment with the IL-1 receptor antagonist anakinra. This patient had severe acute rheumatoid arthritis (Disease Activity Score >6). Initially, he received treatment with 10 mg prednisolone daily along with oral methotrexate 15 mg weekly. Methotrexate was discontinued after 3 months because of repeated liver enzyme elevation. After the disease became more active, he was treated with the IL-1 receptor antagonist along with 10 mg prednisolone daily. One month later, the patient improved significantly, and prednisolone was decreased to 5 mg on alternate days and discontinued after another 3 months. After 23 months of anakinra monotherapy, the patient developed pulmonary TBC and was put on quadruple anti-TBC treatment, which resulted in excellent recovery. Six years before, the patient had pulmonary TBC and received triple anti-TBC treatment for 9 months with complete clinical and radiologic remission. We believe this is the first reported case of TBC reactivation during anakinra treatment.
authors.affiliation: Rheumatology Unit, 1st Department of Medicine, AHEPA General Hospital, University of Thessaloniki, Thessaloniki, Greece. lsettas@the.forthnet.gr
authors.forename: Lucas D
authors.initials: LD
authors.lastname: Settas
authors.forename: George
authors.initials: G
authors.lastname: Tsimirikas
authors.forename: George
authors.initials: G
authors.lastname: Vosvotekas
authors.forename: Eva
authors.initials: E
authors.lastname: Triantafyllidou
authors.forename: Paul
authors.initials: P
authors.lastname: Nicolaides
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D006801:Humans; D053590:Interleukin 1 Receptor Antagonist Protein / Q000009:adverse effects*; D008297:Male; D012008:Recurrence; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000209:etiology*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D053590:Interleukin 1 Receptor Antagonist Protein