title: Clinical characteristics and treatment responses of patients who developed tuberculosis following use of a tumor necrosis factor-α inhibitor.
abstract: OBJECTIVE
  Individuals being treated with tumor necrosis factor (TNF)-α inhibitors are at increased risk of developing tuberculosis (TB). We determined the clinical characteristics and treatment response of patients who developed TB after using TNF-α inhibitors.
  
  
  METHODS
  Patients with TB detected within 12 months of the initiation of TNF-α inhibitor treatment were included, if seen from January 1, 2000 to August 31, 2011. We retrospectively reviewed the clinical records, results of bacteriological examinations, and radiographs of the included patients and the response to anti-TB treatment.
  
  
  RESULTS
  We indentified seven cases of TB in 457 patients treated with TNF-α inhibitors during the study period. TB developed a median of 123 days (range, 48 to 331) after the first dose of TNF-α inhibitor. Pulmonary TB, including TB pleuritis, was diagnosed in three patients and extrapulmonary TB in four. Favorable treatment outcomes were achieved in six of seven patients.
  
  
  CONCLUSIONS
  Among the TNF-α inhibitor users who contracted TB, extrapulmonary sites were common and the treatment response was satisfactory.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Keun Bum
authors.initials: KB
authors.lastname: Chung
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Lee
authors.forename: Jong Pil
authors.initials: JP
authors.lastname: Im
authors.forename: Sung Koo
authors.initials: SK
authors.lastname: Han
authors.forename: Jae-Joon
authors.initials: JJ
authors.lastname: Yim
mesh_terms: D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D059425:Interferon-gamma Release Tests; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology* / Q000382:microbiology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000995:Antitubercular Agents; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha
keywords: Mycobacterium; Tuberculosis; Tumor necrosis factor-alpha