Haemophagocytic syndrome and paradoxical reaction to tuberculostatics after treatment with infliximab.
METHODS
A 44-year-old man was diagnosed with ankylosing spondylitis, on treatment with infliximab. After three doses, he was admitted to hospital with fever, fatigue and nausea. A bone marrow biopsy confirmed haemophagocytic syndrome. He was treated with immunoglobulin, cyclosporine and corticosteroids. CT scan revealed tuberculosis. Tuberculostatic treatment was started 26 days after admission. One month later, he was transferred intensive care with septic shock and acute respiratory distress syndrome. After improvement, he was transferred to the medical ward and later discharged. Two weeks after discharge, he was readmitted with a suspected paradoxical reaction (PR) to tuberculostatics and treated with prednisone. He was discharged 15 days later.


CONCLUSIONS
In patients treated with anti-TNF therapy it may be advisable to monitor the signs and symptoms of tuberculosis. HPS is a rare complication of rheumatic diseases. The possibility of developing a PR in immunosuppressed patients treated with antituberculous should be considered.
Troncoso Mariño
Amelia
A
Department of Pharmacy, Meixoeiro Hospital s/n, 36200, Vigo, Pontevedra, Spain. ameliatroncoso@gmail.com
Campelo Sánchez
Eva
E
Martínez López de Castro
Noemí
N
Inaraja Bobo
María Teresa
MT
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000139:chemically induced; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000069285:Infliximab; D051359:Lymphohistiocytosis, Hemophagocytic / Q000139:chemically induced*; D008297:Male; D011241:Prednisone / Q000627:therapeutic use; D013167:Spondylitis, Ankylosing / Q000150:complications / Q000188:drug therapy*; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000188:drug therapy*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000995:Antitubercular Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D016572:Cyclosporine; D000069285:Infliximab; D011241:Prednisone