[1例接受英夫利昔单抗治疗克罗恩病患者发生急性坏死性皮肤海分枝杆菌感染]
[A case of acute and necrotizing cutaneous Mycobacterium marinum infection in a patient treated with infliximab for Crohn's disease].
作者信息
Guyot A, Begon E, Abramowitz L, Landry J, Marinho E, Descamps V, Crickx B
机构信息
Service de dermatologie, hôpital Bichat, AP-HP, université Paris-VII, 46, rue Henri-Huchard, 75877 Paris cedex 18, France.
出版信息
Ann Dermatol Venereol. 2009 Nov;136(11):806-10. doi: 10.1016/j.annder.2009.09.009. Epub 2009 Oct 23.
BACKGROUND
The increasing use of anti-TNFalpha exposes patients to emerging risks, particularly that of infection. We report a case of severe cutaneous Mycobacterium marinum infection in a patient treated with infliximab and we discuss therapeutic options.
PATIENTS AND METHODS
A man treated with infliximab for Crohn's disease developed a severe cutaneous infection with M. marinum. Despite withdrawal of infliximab and the introduction of triple antibiotic therapy, the patient's lesions worsened and surgical treatment was required.
DISCUSSION
The worsening experienced by our patient 1 week after the beginning of the treatment is comparable with the immune reconstitution syndrome occasionally observed in tuberculosis in immunocompromised hosts, thus raising the question of the potential value of continuing infliximab treatment. Recommendations are needed concerning the prevention and treatment of M. marinum infections in patients on anti-TNFalpha biotherapies.
背景
抗TNFα药物的使用日益增加，使患者面临新出现的风险，尤其是感染风险。我们报告一例接受英夫利昔单抗治疗的患者发生严重皮肤海分枝杆菌感染的病例，并讨论治疗方案。
患者与方法
一名因克罗恩病接受英夫利昔单抗治疗的男性发生了严重的皮肤海分枝杆菌感染。尽管停用了英夫利昔单抗并采用了三联抗生素治疗，但患者的皮损仍恶化，需要手术治疗。
讨论
我们的患者在治疗开始1周后病情恶化，这与免疫功能低下宿主中偶尔在结核病中观察到的免疫重建综合征相当，因此引发了继续使用英夫利昔单抗治疗的潜在价值问题。对于接受抗TNFα生物疗法的患者，需要就海分枝杆菌感染的预防和治疗提出建议。
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