title: Haemophagocytic syndrome and paradoxical reaction to tuberculostatics after treatment with infliximab.
abstract: 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.
authors.affiliation: Department of Pharmacy, Meixoeiro Hospital s/n, 36200, Vigo, Pontevedra, Spain. ameliatroncoso@gmail.com
authors.forename: Amelia
authors.initials: A
authors.lastname: Troncoso Mariño
authors.forename: Eva
authors.initials: E
authors.lastname: Campelo Sánchez
authors.forename: Noemí
authors.initials: N
authors.lastname: Martínez López de Castro
authors.forename: María Teresa
authors.initials: MT
authors.lastname: Inaraja Bobo
mesh_terms: 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
chemical_list: 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