title: Prolonged paradoxical reaction to anti-tuberculous treatment after discontinuation of TNF-alpha- blocker therapy with adalimumab. Rare clinical documentation.
abstract: In the past decades, tumor necrosis factor alpha (TNF-a) antagonist has been a milestone in the treatment of many chronic inflammatory diseases. TNF antagonist can increase patients' susceptibility to many different kinds of infections especially those requiring granuloma formations despite regular performance of Screening for latent tuberculosis infection (LTBI). We report 2 cases of patients who developed tuberculosis under treatment with adalimumab, which was discontinued after the diagnosis of tuberculosis. During the tuberculosis therapy they unexpectedly developed a prolonged paradoxical reaction. In both cases we were only able to manage the progress of the paradoxical reaction through high steroid doses. Patients undergoing therapy with TNF- alpha-blocker are prone to develop tuberculosis infection, which could in turn lead to severe prolonged paradoxical reaction during anti-tuberculous treatment. An increased steroid dose may be required and is sometimes necessary.
authors.affiliation: Klinik Schillerhoehe/RBK, Gerlingen- Stuttgart, Baden- Wuerttemberg, Germany.
authors.forename: Roger Fei
authors.initials: RF
authors.lastname: Falkenstern-Ge
authors.affiliation: Division of Pulmonology, Klinik Schillerhoehe, Center for Pulmonology and Thoracic Surgery, Teaching Hospital of the University of Tuebingen, Solitude Str. 18, 70839 Stuttgart- Gerlingen, Germany.
authors.forename: Kim
authors.initials: K
authors.lastname: Husemann
authors.affiliation: Division of Pulmonology, Klinik Schillerhoehe, Center for Pulmonology and Thoracic Surgery, Teaching Hospital of the University of Tuebingen, Solitude Str. 18, 70839 Stuttgart- Gerlingen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Kohlhäufl
keywords: Adalimumab; IGRA (Interferon Gamma Release Assay); IRIS (immune reconstitution inflammatory syndrome); Paradoxical reaction; SAPHO (synovitis; TNF (tumor necrosis factor); Tuberculosis (TB); acne; hyperostosis; latent tuberculosis infection (LTBI); osteitis) syndrome; pustulosis