Yoon Young Kyung, Kim Jeong Yeon, Sohn Jang Wook, Kim Min Ja, Koo Ja Seol, Choi Jai Hyun, Park Dae Won
J Med Case Rep. 2009 Apr 1;3:6673. doi: 10.1186/1752-1947-3-6673.
The use of the drug infliximab for the treatment of patients with Crohn's disease can be complicated by tuberculosis. A paradoxical reaction during antituberculosis chemotherapy and immunologic reconstitution after discontinuation of infliximab can result in severe disseminated tuberculosis.
A 38-year-old Korean man with severe Crohn's disease presented with fever and diffuse abdominal pain. Infliximab had been started 2 months before admission. A chest X-ray and abdominal computed tomography scan revealed numerous miliary nodules in both lung fields and microabscesses in the spleen. Given the diagnosis of disseminated tuberculosis, the infliximab therapy was discontinued and antituberculosis therapy was promptly started. Over the next 3 months, the patient was diagnosed with tuberculosis lymphadenitis on a right supraclavicular lymph node and surgical excision of the lesion was performed. With the diagnosis of a paradoxical response, anti-tuberculous therapy was continued for 12 months.
Our case suggests that patients who develop tuberculosis after infliximab exposure are at an increased risk of developing a paradoxical reaction. The current recommendation of discontinuing infliximab during tuberculosis treatment should be re-evaluated.
使用英夫利昔单抗治疗克罗恩病患者可能并发结核病。抗结核化疗期间的矛盾反应以及停用英夫利昔单抗后的免疫重建可导致严重播散性结核病。
一名38岁患有严重克罗恩病的韩国男性出现发热和弥漫性腹痛。入院前2个月开始使用英夫利昔单抗。胸部X线和腹部计算机断层扫描显示双肺野有大量粟粒结节，脾脏有微脓肿。鉴于诊断为播散性结核病，停用英夫利昔单抗治疗并立即开始抗结核治疗。在接下来的3个月里，患者右侧锁骨上淋巴结被诊断为结核性淋巴结炎，并对病变进行了手术切除。由于诊断为矛盾反应，抗结核治疗持续了12个月。
我们的病例表明，英夫利昔单抗暴露后发生结核病的患者出现矛盾反应的风险增加。应重新评估目前在结核病治疗期间停用英夫利昔单抗的建议。
