A life-threatening central nervous system-tuberculosis inflammatory reaction nonresponsive to corticosteroids and successfully controlled by infliximab in a young patient with a variant of juvenile idiopathic arthritis.
We report a young patient with a variant of juvenile idiopathic arthritis, who, after 4 years of infliximab treatment, developed miliary tuberculosis (TB) with central nervous system involvement (meningitis and multiple tuberculomas). After anti-TB treatment, clinical and radiologic responses were observed, but severe cerebrospinal fluid and brain inflammatory reaction, nonresponsive to corticosteroids, persisted. It was considered a life-threatening paradoxical reaction based on initial cerebrospinal fluid isolation of Mycobacterium tuberculosis fully sensitive to primary anti-TB drugs. After 4 months in the hospital, infliximab was administered considering that infliximab is a potent tumor necrosis factor α inhibiting agent that participates in the formation and preservation of granulomas and may help to modulate the exaggerated cell-mediated immune response against mycobacterial antigens. Clinical complications associated to brain inflammation resolved, and after 3 years of follow-up, the patient remains self-sufficient without neurologic sequels.
Rheumatology Department, Centro Médico ISSEMYM, Toluca, México. jorjaimes@yahoo.com
Jaimes-Hernández
JH
Jorge
Cárdenas
C
Graciela
Aranda-Pereira
AP
Pablo
Soto-Hernández José
SH
Luis
D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use; D001171:Arthritis, Juvenile / Q000188:drug therapy*; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab; D008279:Magnetic Resonance Imaging; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D014057:Tomography, X-Ray Computed; D014390:Tuberculosis, Meningeal / Q000188:drug therapy*; D014391:Tuberculosis, Miliary / Q000188:drug therapy*; D055815:Young Adult
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D000995:Antitubercular Agents; D005938:Glucocorticoids; D000069285:Infliximab