Jun Yu Kyung, Chun Jaeyoung, Kang Eun Ae, Lee Hyun Jung, Im Jong Pil, Kim Joo Sung
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Korean J Gastroenterol. 2019 Sep 25;74(3):168-174. doi: 10.4166/kjg.2019.74.3.168.
Anti-tumor necrosis factor (anti-TNF) is an effective biological agent for the treatment of moderate-to-severe active ulcerative colitis (UC) refractory to conventional therapy. On the other hand, anti-TNF therapy is strongly associated with a potential risk of tuberculosis (TB). Active TB is a critical complication that makes it difficult to treat patients who require anti-TNF for the treatment of UC refractory to conventional therapy. Based on the clinical guidelines, patients with inflammatory bowel disease (IBD) are strongly recommended to screen for latent TB before anti-TNF administration. Considering the possibility of active or reactivated TB related to anti-TNF therapy, all patients with IBD should be monitored closely for TB during anti-TNF therapy, irrespective of the screening results for latent TB. In particular, the risk of anti-TNF-related multidrug-resistant TB (MDR-TB) in patients with IBD has not been elucidated. This paper reports the first case of disseminated MDR-TB that developed in a UC patient receiving infliximab despite the negative evaluation for latent TB screening.
抗肿瘤坏死因子（抗TNF）是治疗对传统疗法难治的中重度活动性溃疡性结肠炎（UC）的一种有效生物制剂。另一方面，抗TNF治疗与结核病（TB）的潜在风险密切相关。活动性TB是一种严重并发症，使得那些需要抗TNF治疗对传统疗法难治的UC患者难以得到治疗。根据临床指南，强烈建议炎症性肠病（IBD）患者在给予抗TNF治疗前筛查潜伏性TB。考虑到与抗TNF治疗相关的活动性或再激活TB的可能性，所有IBD患者在抗TNF治疗期间均应密切监测TB，无论潜伏性TB的筛查结果如何。特别是，IBD患者中抗TNF相关耐多药TB（MDR-TB）的风险尚未阐明。本文报告了首例在接受英夫利昔单抗治疗的UC患者中发生播散性MDR-TB的病例，尽管其潜伏性TB筛查评估为阴性。
