Prolonged paradoxical response to anti-tuberculous treatment after infliximab.
A 56-year-old woman with ankylosing spondylitis, treated for 3 months with infliximab, developed miliary tuberculosis with mediastinal lymphadenopathies and brain and splenic lesions. After initial improvement under anti-tuberculous therapy, she suffered an unexpectedly prolonged paradoxical worsening with several episodes of lymphadenopathy, including life-threatening ones, over a period of more than 14 months of follow-up. The outcome was favorable as a result of corticosteroid and surgical treatments. This phenomenon reflects a paradoxical reaction precipitated by infliximab withdrawal.
Melboucy-Belkhir
Sara
S
Service de Médecine Interne, Hôpital Jean-Verdier, Assistance Publique-Hôpitaux de Paris, Université Paris 13, avenue du 14 Juillet, Bondy Cedex, France. melboucysara@yahoo.fr
Flexor
Gabriella
G
Stirnemann
Jérôme
J
Morin
Anne-Sophie
AS
Boukari
Latifatou
L
Polliand
Claude
C
Cruaud
Philippe
P
Fain
Olivier
O
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D000069285:Infliximab; D008206:Lymphatic Diseases / Q000209:etiology / Q000601:surgery / Q000628:therapy; D008477:Mediastinal Diseases / Q000209:etiology / Q000628:therapy; D008875:Middle Aged; D009894:Opportunistic Infections / Q000209:etiology / Q000628:therapy; D012008:Recurrence; D013167:Spondylitis, Ankylosing / Q000628:therapy*; D014391:Tuberculosis, Miliary / Q000209:etiology* / Q000628:therapy*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
D000305:Adrenal Cortex Hormones; D000911:Antibodies, Monoclonal; D000995:Antitubercular Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab