Iliopoulos A, Psathakis K, Aslanidis S, Skagias L, Sfikakis P P
Department of Rheumatology, Army General Hospital of Athens, Athens, Greece.
Int J Tuberc Lung Dis. 2006 May;10(5):588-90.
In patients receiving anti-tumor necrosis factor (TNF) therapy, a probable exacerbation of latent tuberculosis (TB) is a major adverse event. The impairment of granuloma differentiation is considered a characteristic feature of TB in these patients. In this report we present three patients with rheumatic disease who developed TB under infliximab treatment. All of them had typical granulomas on the biopsy specimens, indicating that the expected impairment of granuloma formation is not always the case. The notion of granuloma-free TB in patients receiving anti-TNF therapy could shift a clinician's path away from performing a biopsy, thus delaying the establishment of a correct diagnosis.
在接受抗肿瘤坏死因子（TNF）治疗的患者中，潜伏性结核病（TB）可能加重是一种主要不良事件。肉芽肿分化受损被认为是这些患者结核病的一个特征。在本报告中，我们介绍了3例在英夫利昔单抗治疗期间发生结核病的风湿病患者。他们所有的活检标本都有典型的肉芽肿，这表明预期的肉芽肿形成受损情况并非总是如此。接受抗TNF治疗的患者无肉芽肿性结核病这一概念可能会使临床医生不进行活检，从而延误正确诊断的确立。
