The role of interferon-gamma release assays in predicting the emergence of active tuberculosis in the setting of biological treatment: a case report and review of the literature.
Conversions and reversions of interferon-gamma (IFN-γ) release assays (IGRAs) were observed when these tests were repeated over time in the same individuals, including those treated with biological agents. In most studies, the variability of IFN-γ plasma levels was not paralleled by clinical change, but a few exceptions exist, in which IGRA conversion predicted the emergence of active tuberculosis (TB). We report the case of a Peruvian patient with rheumatoid arthritis (RA) and Crohn's disease scheduled for treatment with adalimumab. TB screening demonstrated latent TB infection (LTBI), and the patient was started on isoniazid (INH) for 9 months. Adalimumab was initiated after 1 month since INH. QuantiFERON-TB Gold In-Tube, one of the IGRAs currently available, was serially repeated to monitor the status of TB infection during treatment with the biological agent. The patient developed active TB preceded by progressively rising levels of released IFN-γ. We came to know that she had withdrawn INH after 2 months on her own initiative. Considering the low rate of INH completion, serial IGRAs may help in the clinical vigilance during prophylaxis as well as anti-TNF treatment, at least in patients presenting other risk factors aside from the state of immunosuppression.
Dipartimento di Medicina Interna e Specialità Mediche, Reumatologia, Sapienza Università di Roma, viale del Policlinico 155, 00161, Rome, Italy. rossana.scrivo@uniroma1.it.
Rossana
R
Scrivo
Dipartimento di Sanità Pubblica e Malattie Infettive, Sapienza Università di Roma, viale del Policlinico 155, 00161, Rome, Italy.
Ilaria
I
Sauzullo
Dipartimento di Sanità Pubblica e Malattie Infettive, Sapienza Università di Roma, viale del Policlinico 155, 00161, Rome, Italy.
Fabio
F
Mengoni
Dipartimento di Medicina Interna e Specialità Mediche, Reumatologia, Sapienza Università di Roma, viale del Policlinico 155, 00161, Rome, Italy.
Valeria
V
Riccieri
Dipartimento Malattie Polmonari, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy.
Alfonso Maria
AM
Altieri
Cattedra di Gastroenterologia, Università Campus Bio-Medico, Rome, Italy.
Laura
L
Cantoro
Dipartimento di Sanità Pubblica e Malattie Infettive, Sapienza Università di Roma, viale del Policlinico 155, 00161, Rome, Italy.
Vincenzo
V
Vullo
Dipartimento di Sanità Pubblica e Malattie Infettive, Sapienza Università di Roma, viale del Policlinico 155, 00161, Rome, Italy.|UOC Malattie Infettive, Fondazione Eleonora Lorillard Spencer Cenci, Sapienza Università di Roma (Polo Pontino), Latina, Italy.
Claudio Maria
CM
Mastroianni
Dipartimento di Medicina Interna e Specialità Mediche, Reumatologia, Sapienza Università di Roma, viale del Policlinico 155, 00161, Rome, Italy.
Guido
G
Valesini
D000068879:Adalimumab / Q000009:adverse effects* / Q000627:therapeutic use; D000328:Adult; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy*; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D059425:Interferon-gamma Release Tests; D007538:Isoniazid / Q000627:therapeutic use; D055985:Latent Tuberculosis / Q000175:diagnosis / Q000188:drug therapy; D014376:Tuberculosis / Q000139:chemically induced* / Q000175:diagnosis
D018501:Antirheumatic Agents; D000995:Antitubercular Agents; D000068879:Adalimumab; D007538:Isoniazid
Adalimumab; IGRA; QuantiFERON-TB Gold In-Tube; Rheumatoid arthritis; TNF antagonists; Tuberculosis