title: Oral tuberculosis in a patient with rheumatoid arthritis after long treatment with methotrexate and adalimumab.
abstract: The treatment of rheumatoid arthritis (RA) with tumor necrosis factor α (TNF-α) inhibitors has been associated with an increased risk of tuberculosis (TB). Most patients have extrapulmonary disease. We describe a case of tonsil TB in an RA patient treated with methotrexate for 23 years and adalimumab (TNF-α inhibitor) for the last 3 years after an initial negative PPD (purified protein derivative of tuberculin) skin test. Our patient presented with a tonsil ulcer. PPD skin test was now positive; biopsy result of the lesion revealed Mycobacterium tuberculosis on culture, and a granuloma typical of TB on histologic assessment. The patient received antituberculous treatment with complete resolution of the lesion. This case illustrates that oral TB can occur after long treatment with TNF-α inhibitor and that tuberculous granulomas can be formed in such patients.
authors.affiliation: Department of Rheumatology, Thessaly University School of Medicine and Hospital, Larissa, Greece.
authors.forename: Georgia
authors.initials: G
authors.lastname: Barouta
authors.forename: Maria
authors.initials: M
authors.lastname: Karapetsa
authors.forename: Evanthia
authors.initials: E
authors.lastname: Kostopoulou
authors.forename: Ioannis
authors.initials: I
authors.lastname: Alexiou
authors.forename: Georgios
authors.initials: G
authors.lastname: Koukoulis
authors.forename: Lazaros I
authors.initials: LI
authors.lastname: Sakkas
mesh_terms: D000068879:Adalimumab; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents / Q000008:administration & dosage*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D004334:Drug Administration Schedule; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage*; D014066:Palatine Tonsil; D014393:Tuberculosis, Oral / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents; D000068879:Adalimumab; D008727:Methotrexate