title: [Two cases of tuberculosis after treatment of rheumatoid arthritis with infliximab].
abstract: We report two cases of tuberculosis (TB) after treatment with infliximab (IFX) for rheumatoid arthritis (RA). The first case, a 69-year-old woman with RA, developed miliary TB with acute respiratory distress syndrome 21 months after initiation of IFX therapy. Sputum samples revealed smears and cultures positive for Mycobacterium tuberculosis and also positive polymerase chain reaction for TB (PCR-TB); in addition urine samples were smear-negative and culture-positive for TB. She was treated with corticosteroid pulse therapy and anti-tuberculosis drugs, and recovered. The second case, a 51-year-old man with RA, had had contact with a tuberculosis patient four years after initiation of IFX therapy. One year later, he developed pulmonary and pleural tuberculosis. Mycobacterium tuberculosis was detected in the bronchial lavage fluid and pleural effusion (smear-negative and culture- and PCR-TB positive). He clinically improved by treatment with anti-tuberculosis drugs. In both cases, the enzyme-linked immunosorbent spot (ELISPOT) tests revealed positive responses although the QuantiFERON TB-2G tests were not positive. We suggest that the ELISPOT test may be useful as a supportive diagnostic tool for tuberculosis in immunocompromised conditions including RA treated with a tumor necrosis factor-alpha (TNF-alpha) inhibitor.
authors.affiliation: Department of Respiratory Diseases, National Hospital Organization Tokyo Hospital.
authors.forename: Naoki
authors.initials: N
authors.lastname: Takasaka
authors.forename: Emiko
authors.initials: E
authors.lastname: Toyota
authors.forename: Masahiro
authors.initials: M
authors.lastname: Shimada
authors.forename: Haruyuki
authors.initials: H
authors.lastname: Ariga
authors.forename: Shinji
authors.initials: S
authors.lastname: Teramoto
authors.forename: Shinobu
authors.initials: S
authors.lastname: Akagawa
mesh_terms: D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D014376:Tuberculosis / Q000175:diagnosis / Q000209:etiology*
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D000069285:Infliximab