Department of Pediatric Cardiology and Intensive Care Medicine, Klinikum Stuttgart Olgahospital, Bismarckstr, 8, 70176 Stuttgart, Germany.
Eur J Pediatr. 2011 Oct;170(10):1337-42. doi: 10.1007/s00431-011-1501-y. Epub 2011 May 31.
Life-threatening disseminated tuberculosis developed in a 17-year-old girl who was treated with the TNF-α blocker adalimumab for refractory SAPHO syndrome. The patient presented to the emergency department with dyspnea and somnolence and within 2 h developed the clinical picture of a septic shock. In addition to this unusual presentation, she showed a complicated course with increasing cerebral granuloma formation in spite of adequate antimycobacterial treatment. Immune reconstitution after discontinuation of TNF blockade may contribute to this "paradoxical reaction." Possible implications for screening, diagnosis, and treatment of tuberculosis in children and adolescents receiving anti-TNF treatment are discussed.
17 岁女孩因难治性 SAPHO 综合征接受 TNF-α 阻滞剂阿达木单抗治疗后，发生危及生命的播散性肺结核。患者因呼吸困难和嗜睡到急诊就诊，2 小时内出现感染性休克的临床表现。除了这种不常见的表现外，尽管进行了适当的抗分枝杆菌治疗，她的病情仍很复杂，脑内肉芽肿形成增多。TNF 阻断后免疫重建可能导致这种“矛盾反应”。讨论了在接受抗 TNF 治疗的儿童和青少年中筛查、诊断和治疗肺结核的可能影响。
