Bouchentouf R, Yasser Z, Aitbenasser M A
Service de pneumologie, hôpital militaire Avicenne, Marrakech, Maroc; Laboratoire PCIM, FMPM, université Cadi-Ayyad, Marrakech, Maroc.
Service de pneumologie, hôpital militaire Avicenne, Marrakech, Maroc.
Rev Pneumol Clin. 2014 Dec;70(6):366-9. doi: 10.1016/j.pneumo.2014.07.002. Epub 2014 Aug 15.
Anti-tumor necrosis factor (TNF) therapy has been the major advance in the treatment of inflammatory bowel disease, especially Crohn's disease. But there is a higher risk of infections, especially tuberculosis (TB), in patients treated with anti-TNFα. The authors report a case of disseminated tuberculosis with the following features: pulmonary tuberculosis, left supra clavicular cervical and meditational lymphadenopathy, bilateral pleural effusion, peritoneal and splenic involvement. This disseminated tuberculosis was observed in a 39-year-old woman who was treated by infliximab for refractory Crohn's disease. The evolution with antituberculosis drugs was fatal, the death of the patient was due to hepatic encephalitis.
The physicians should always be aware in the use of TNF-alpha blockers according to guidelines. Its recommended to realize a complete pretherapeutic assessment and it is necessary to follow-up the patients to detect possible reactivation of latent tuberculosis.
抗肿瘤坏死因子(TNF)疗法一直是炎症性肠病尤其是克罗恩病治疗的重大进展。但接受抗TNFα治疗的患者感染风险更高,尤其是结核病(TB)。作者报告了一例播散性结核病,具有以下特征:肺结核、左锁骨上颈及纵隔淋巴结肿大、双侧胸腔积液、腹膜及脾脏受累。该播散性结核病见于一名39岁女性,她因难治性克罗恩病接受英夫利昔单抗治疗。抗结核药物治疗的病程是致命的,患者死于肝性脑病。
医生在使用TNF-α阻滞剂时应始终按照指南保持警惕。建议进行全面的治疗前评估,并且有必要对患者进行随访以检测潜在结核病可能的再激活。