title: Paradoxical exacerbation of tuberculosis after TNFα antagonist discontinuation: beware of immune reconstitution inflammatory syndrome.
abstract: Paradoxical worsening of tuberculosis associated with immune reconstitution during antiretroviral therapy in patients with HIV infection is known as the immune reconstitution inflammatory syndrome (IRIS). Here, we report a case of paradoxical worsening of IFN-alpha induced tuberculosis in a patient experiencing reconstitution of pathogen-specific immune responses after discontinuing TNFα antagonist therapy. This case serves to alert clinicians that complications such as tuberculosis may worsen after TNFα antagonist discontinuation. This situation may paradoxically require readministration of the immunosuppressive drug in some patients.
authors.affiliation: Service de Médecine Interne, Université Paris 7, Hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Rivoisy
authors.forename: Lucile
authors.initials: L
authors.lastname: Amrouche
authors.forename: Guislaine
authors.initials: G
authors.lastname: Carcelain
authors.forename: Daniel
authors.initials: D
authors.lastname: Séréni
authors.forename: Anne
authors.initials: A
authors.lastname: Bourgarit
mesh_terms: D000068879:Adalimumab; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D000995:Antitubercular Agents / Q000627:therapeutic use; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000175:diagnosis* / Q000276:immunology; D055985:Latent Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D028761:Withholding Treatment
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000995:Antitubercular Agents; D005938:Glucocorticoids; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab