ABSTRACT
No disponible
Subject(s)
Humans , Female , Adult , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Adalimumab/adverse effects , Peritonitis, Tuberculous/chemically induced , Arthritis, Rheumatoid/drug therapy , Diagnosis, Differential , Ascitic Fluid/cytology , Abdominal Pain/etiologyABSTRACT
A 67-year-old man presented with fever, night sweat and abdominal complaints for about 4 weeks. Ultrasound and a computed tomography scan showed distinct ascites as the main finding, presenting as exsudate with predominating lymphoid cells. Because of long-term immunosuppressive therapy with the tumor necrosis factor (TNF)-α inhibitor golimumab for psoriasis, the suspicion for a possible tuberculous peritonitis arose. This was confirmed with an enzyme-linked immunospot assay, a high level of adenosine deaminase in the ascites and a peritoneum which was studded with multiple whitish nodules, corresponding to granulomas with giant cells. With a standard antituberculous regimen the symptoms were quickly relieved and finally complete restitution was achieved.
Subject(s)
Antibodies, Monoclonal/adverse effects , Ascites/etiology , Fever of Unknown Origin/etiology , Peritonitis, Tuberculous/chemically induced , Psoriasis/drug therapy , Sweating , Adenosine Deaminase/metabolism , Aged , Antibodies, Monoclonal/therapeutic use , Circadian Rhythm , Diagnosis, Differential , Enzyme-Linked Immunospot Assay , Humans , Male , Peritonitis, Tuberculous/diagnosisABSTRACT
Opportunistic infection and reactivation of latent infection has been reported with use of monoclonal TNF alpha antibodies used for treatment of severe rheumatoid arthritis. We present a case of peritoneal tuberculosis (TB) causing renal failure secondary to ureteral constriction in a patient who had been treated with infliximab for rheumatoid arthritis. We suggest that physicians should be aware of the increased risk of false negative and false positive TST and IGRA among patients treated with monoclonal TNF alpha antibodies and should regularly look for usual and unusual symptoms of TB in this patient population.
Subject(s)
Acute Kidney Injury/etiology , Antibodies, Monoclonal/adverse effects , Antirheumatic Agents/adverse effects , Arthritis, Rheumatoid/drug therapy , Peritonitis, Tuberculous/complications , Aged , Arthritis, Rheumatoid/complications , Female , Humans , Infliximab , Peritonitis, Tuberculous/chemically induced , Ureteral Obstruction/complicationsABSTRACT
A case of multiple organ tuberculosis (TBc) involving lung, pleura, and peritoneum in a 39-year-old man with long-standing ankylosing spondylitis (AS) treated with adalimumab was presented. The relationship between antitumor necrosis factor-α (anti-TNF-α) therapy and TBc was also reviewed. This case illustrates that TBc can develop in multiple organs during adalimumab therapy, and thus, the awareness of serious complications of multiple organs and atypical extrapulmonary pattern of TBc during anti-TNF-α therapy needs to be increased.