Luquín Nuria, Masiá Mar, Noguera Raúl, Gutiérrez Félix
Infectious Diseases Unit, Hospital General Universitario de Elche, Elche, Spain.
Infectious Diseases Unit, Hospital General Universitario de Elche, Elche, Spain Medicina Clínica, Universidad Miguel Hernandez, Elche, Alicante, Spain.
BMJ Case Rep. 2014 Nov 24;2014:bcr2014206976. doi: 10.1136/bcr-2014-206976.
A 42-year-old man receiving anti-tumour necrosis factor α (anti-TNFα) therapy with adalimumab due to psoriatic arthritis presented with a 2-month-old anal ulcer. An apical right lung infiltrate was found in his chest X-ray, although he had no pulmonary symptoms. Two biopsies of the ulcer were taken and reported as granulomatous, necrotising, with chronic inflammation (first), and as hyperplasic epidermis with linfocitary infiltrate and the presence of plenty of plasmatic cells (second). Histochemical techniques, including Ziehl-Neelsen, Grocott and periodic acid-Schiff stains, and PCR for Mycobacterium tuberculosis on both biopsies were negative. Serology for HIV, syphilis and hepatitis were also negative. In the second biopsy culture, moderate colonies of M. tuberculosis finally grew. The patient started a four-drug antituberculosis regimen. Adalimumab was discontinued and etanercept introduced after 2 months of antituberculosis therapy. The patient remained on therapy for 9 months with complete ulcer resolution.
一名42岁男性因银屑病关节炎接受阿达木单抗抗肿瘤坏死因子α（抗TNFα）治疗，出现了一个2个月大的肛门溃疡。胸部X线检查发现其右肺尖有浸润影，尽管他没有肺部症状。对溃疡进行了两次活检，第一次活检报告为肉芽肿性、坏死性伴慢性炎症，第二次活检报告为表皮增生伴淋巴细胞浸润及大量浆细胞存在。包括萋-尼氏染色、格罗科特染色和过碘酸-希夫染色在内的组织化学技术以及两次活检的结核分枝杆菌聚合酶链反应均为阴性。HIV、梅毒和肝炎的血清学检查也为阴性。在第二次活检培养中，最终培养出中等量的结核分枝杆菌菌落。患者开始接受四联抗结核治疗方案。停用阿达木单抗，在抗结核治疗2个月后换用依那西普。患者持续治疗9个月，溃疡完全愈合。
