Takasaka Naoki, Toyota Emiko, Shimada Masahiro, Ariga Haruyuki, Teramoto Shinji, Akagawa Shinobu
Department of Respiratory Diseases, National Hospital Organization Tokyo Hospital.
Nihon Kokyuki Gakkai Zasshi. 2010 Jan;48(1):60-5.
We report two cases of tuberculosis (TB) after treatment with infliximab (IFX) for rheumatoid arthritis (RA). The first case, a 69-year-old woman with RA, developed miliary TB with acute respiratory distress syndrome 21 months after initiation of IFX therapy. Sputum samples revealed smears and cultures positive for Mycobacterium tuberculosis and also positive polymerase chain reaction for TB (PCR-TB); in addition urine samples were smear-negative and culture-positive for TB. She was treated with corticosteroid pulse therapy and anti-tuberculosis drugs, and recovered. The second case, a 51-year-old man with RA, had had contact with a tuberculosis patient four years after initiation of IFX therapy. One year later, he developed pulmonary and pleural tuberculosis. Mycobacterium tuberculosis was detected in the bronchial lavage fluid and pleural effusion (smear-negative and culture- and PCR-TB positive). He clinically improved by treatment with anti-tuberculosis drugs. In both cases, the enzyme-linked immunosorbent spot (ELISPOT) tests revealed positive responses although the QuantiFERON TB-2G tests were not positive. We suggest that the ELISPOT test may be useful as a supportive diagnostic tool for tuberculosis in immunocompromised conditions including RA treated with a tumor necrosis factor-alpha (TNF-alpha) inhibitor.
我们报告了两例类风湿关节炎（RA）患者在接受英夫利昔单抗（IFX）治疗后发生结核病（TB）的病例。第一例，一名69岁的RA女性，在开始IFX治疗21个月后发生粟粒性结核并伴有急性呼吸窘迫综合征。痰标本涂片和培养显示结核分枝杆菌阳性，结核聚合酶链反应（PCR-TB）也呈阳性；此外，尿标本涂片阴性但培养结核阳性。她接受了糖皮质激素冲击治疗和抗结核药物治疗后康复。第二例，一名51岁的RA男性，在开始IFX治疗四年后与一名结核病患者有过接触。一年后，他发生了肺结核和结核性胸膜炎。在支气管灌洗液和胸腔积液中检测到结核分枝杆菌（涂片阴性，培养和PCR-TB阳性）。他通过抗结核药物治疗后临床症状改善。在这两例中，酶联免疫斑点（ELISPOT）试验显示阳性反应，尽管结核感染T细胞检测（QuantiFERON TB-2G）试验为阴性。我们建议，在包括接受肿瘤坏死因子-α（TNF-α）抑制剂治疗的RA在内的免疫功能低下情况下，ELISPOT试验可能作为结核病的辅助诊断工具。
