title: Life-threatening disseminated tuberculosis as a complication of TNF-α blockade in an adolescent.
abstract: Life-threatening disseminated tuberculosis developed in a 17-year-old girl who was treated with the TNF-α blocker adalimumab for refractory SAPHO syndrome. The patient presented to the emergency department with dyspnea and somnolence and within 2 h developed the clinical picture of a septic shock. In addition to this unusual presentation, she showed a complicated course with increasing cerebral granuloma formation in spite of adequate antimycobacterial treatment. Immune reconstitution after discontinuation of TNF blockade may contribute to this "paradoxical reaction." Possible implications for screening, diagnosis, and treatment of tuberculosis in children and adolescents receiving anti-TNF treatment are discussed.
authors.affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, Klinikum Stuttgart Olgahospital, Bismarckstr, 8, 70176 Stuttgart, Germany. s.hess@klinikum-stuttgart.de
authors.forename: Steffen
authors.initials: S
authors.lastname: Hess
authors.forename: Toni
authors.initials: T
authors.lastname: Hospach
authors.forename: Robert
authors.initials: R
authors.lastname: Nossal
authors.forename: Günther
authors.initials: G
authors.lastname: Dannecker
authors.forename: Klaus
authors.initials: K
authors.lastname: Magdorf
authors.forename: Frank
authors.initials: F
authors.lastname: Uhlemann
mesh_terms: D020083:Acquired Hyperostosis Syndrome / Q000188:drug therapy* / Q000276:immunology; D000068879:Adalimumab; D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D000995:Antitubercular Agents / Q000627:therapeutic use; D001372:Aza Compounds / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004417:Dyspnea / Q000382:microbiology; D004977:Ethambutol / Q000627:therapeutic use; D005260:Female; D024841:Fluoroquinolones; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D000077266:Moxifloxacin; D011804:Quinolines / Q000627:therapeutic use; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000382:microbiology; D016896:Treatment Outcome; D014391:Tuberculosis, Miliary / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000893:Anti-Inflammatory Agents; D061067:Antibodies, Monoclonal, Humanized; D000995:Antitubercular Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D007166:Immunosuppressive Agents; D011804:Quinolines; D014409:Tumor Necrosis Factor-alpha; D004977:Ethambutol; D000068879:Adalimumab; D000077266:Moxifloxacin