Tuberculosis and TNF-inhibitors: history of exposure should outweigh investigations
Tuberculosis and TNF-inhibitors: history of exposure should outweigh investigations
A 39-year-old Indian man was diagnosed with ulcerative colitis on colonic biopsy and started on mesalazine, prednisolone and azathioprine. However, the colitis remained active and required antitumour necrosis factor (TNF) treatment with infliximab. Prior to starting infliximab, his chest X-ray was normal and QuantiFERON interferon ? release assay for tuberculosis (TB) was negative. However, his wife had been treated for pulmonary TB 11 years previously when they were cohabiting. On attending for his third dose of infliximab, he was feverish and tachycardic, and was admitted for investigation. Chest X-ray on admission showed changes consistent with miliary TB, and thoracic CT confirmed extensive miliary nodules with supraclavicular and mediastinal lymphadenopathy. Abdominal CT showed multiple mesenteric lymph nodes. Subsequent bronchoalveolar lavage, neck lymph node aspirate and colonic biopsies all cultured Mycobacterium tuberculosis. In retrospect, a clear history of close household TB exposure should have precipitated consideration of TB chemoprophylaxis prior to anti-TNF treatment.
Reichmann, M.T.
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Marshall, B.G.
9abf382c-977f-459c-9b91-5ed8cbf2284f
Cummings, F.
ef30e7fc-e645-4b68-a8d2-f3c3cc79eff4
Elkington, P.T.
60828c7c-3d32-47c9-9fcc-6c4c54c35a15
5 May 2014
Reichmann, M.T.
d887f227-13a8-4384-a1c5-d3c229cd0642
Marshall, B.G.
9abf382c-977f-459c-9b91-5ed8cbf2284f
Cummings, F.
ef30e7fc-e645-4b68-a8d2-f3c3cc79eff4
Elkington, P.T.
60828c7c-3d32-47c9-9fcc-6c4c54c35a15
Reichmann, M.T., Marshall, B.G., Cummings, F. and Elkington, P.T.
(2014)
Tuberculosis and TNF-inhibitors: history of exposure should outweigh investigations.
BMJ Case Reports, 2014.
(doi:10.1136/bcr-2013-202127).
(PMID:24798354)
Abstract
A 39-year-old Indian man was diagnosed with ulcerative colitis on colonic biopsy and started on mesalazine, prednisolone and azathioprine. However, the colitis remained active and required antitumour necrosis factor (TNF) treatment with infliximab. Prior to starting infliximab, his chest X-ray was normal and QuantiFERON interferon ? release assay for tuberculosis (TB) was negative. However, his wife had been treated for pulmonary TB 11 years previously when they were cohabiting. On attending for his third dose of infliximab, he was feverish and tachycardic, and was admitted for investigation. Chest X-ray on admission showed changes consistent with miliary TB, and thoracic CT confirmed extensive miliary nodules with supraclavicular and mediastinal lymphadenopathy. Abdominal CT showed multiple mesenteric lymph nodes. Subsequent bronchoalveolar lavage, neck lymph node aspirate and colonic biopsies all cultured Mycobacterium tuberculosis. In retrospect, a clear history of close household TB exposure should have precipitated consideration of TB chemoprophylaxis prior to anti-TNF treatment.
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Published date: 5 May 2014
Organisations:
Faculty of Medicine
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Local EPrints ID: 365603
URI: http://eprints.soton.ac.uk/id/eprint/365603
ISSN: 1757-790X
PURE UUID: de82d103-9cbb-497c-8f3a-4beac37a0cd0
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Date deposited: 10 Jun 2014 14:46
Last modified: 30 Nov 2024 02:55
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Author:
M.T. Reichmann
Author:
F. Cummings
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