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一名强直性脊柱炎患者使用英夫利昔单抗后发生腹部结核:风险是否仍然过高?一例病例报告。

Abdominal tuberculosis in a patient with ankylosing spondylitis and infliximab: is the risk still too great? A case report.

作者信息

Moyón Miguel Ángel, Añazco Johan Stephany, Vásconez Alex Enrique, Larreategui David, Torres María Belén, Moyón Natali, Borja Tatiana, Molina Gabriel Alejandro

机构信息

Department of General Surgery, Clínica Pasteur & School of Medicine, Pontificia Universidad Católica del Ecuador (PUCE), Av. Eloy Alfaro, N29-248, Quito 170515, Ecuador.

Department of General Surgery, Clínica Pasteur, Av. Eloy Alfaro, N29-248, Quito 170515, Ecuador.

出版信息

J Surg Case Rep. 2025 Jun 16;2025(6):rjaf422. doi: 10.1093/jscr/rjaf422. eCollection 2025 Jun.

DOI:10.1093/jscr/rjaf422
PMID:40525094
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12168116/
Abstract

Ankylosing spondylitis is a chronic inflammatory spondyloarthropathy that will cause severe symptoms and complications if left untreated. Anti-TNF-α inhibitor is the treatment of choice, yet all treatments have difficulties, and opportunistic infections following this therapy are well known. Reactivation of latent tuberculosis (TB) and abdominal TB is a serious problem in this therapy since diagnosis is difficult, as symptoms are nonspecific, and complications can be fatal. We present the case of a 47-year-old female doctor with a past medical history of ankylosing spondylitis; she was treated with infliximab. She began developing abdominal pain that led to an acute abdomen due to abdominal TB. After successful treatment, she fully recovered, and the patient is doing well in follow-ups.

摘要

强直性脊柱炎是一种慢性炎症性脊柱关节病,若不治疗会导致严重症状及并发症。抗TNF-α抑制剂是首选治疗方法,但所有治疗都存在困难,且这种治疗后机会性感染是众所周知的。潜伏性结核(TB)和腹部结核的再激活是该治疗中的一个严重问题,因为诊断困难,症状不具特异性,且并发症可能致命。我们报告一例47岁女性医生的病例,她有强直性脊柱炎病史,接受了英夫利昔单抗治疗。她开始出现腹痛,最终因腹部结核导致急腹症。成功治疗后,她完全康复,且患者在随访中情况良好。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c482/12168116/51db7060d624/rjaf422f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c482/12168116/2a33800c844a/rjaf422f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c482/12168116/7a8c1b6e70f2/rjaf422f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c482/12168116/51db7060d624/rjaf422f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c482/12168116/2a33800c844a/rjaf422f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c482/12168116/7a8c1b6e70f2/rjaf422f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c482/12168116/51db7060d624/rjaf422f3.jpg

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本文引用的文献

1
Development of Spinal Tuberculosis in an Adolescent With Crohn's Disease After Infliximab Therapy: A Case Report With Literature Review.英夫利昔单抗治疗后一名克罗恩病青少年发生脊柱结核:病例报告及文献复习
Front Pediatr. 2022 Feb 9;9:802298. doi: 10.3389/fped.2021.802298. eCollection 2021.
2
A rare localization of tuberculosis under infliximab treatment: Testicular involvement.英夫利昔单抗治疗下结核病的罕见定位:睾丸受累。
Turk J Phys Med Rehabil. 2021 Sep 1;67(3):374-377. doi: 10.5606/tftrd.2021.5135. eCollection 2021 Sep.
3
Risk of Tuberculosis in Patients With Inflammatory Bowel Disease on Infliximab or Adalimumab Is Dependent on the Local Disease Burden of Tuberculosis: A Systematic Review and Meta-Analysis.
英夫利昔单抗或阿达木单抗治疗炎症性肠病患者的结核发病风险取决于当地结核病负担:系统评价和荟萃分析。
Am J Gastroenterol. 2020 Mar;115(3):340-349. doi: 10.14309/ajg.0000000000000527.
4
Incidence of tuberculosis in patients receiving anti-TNF therapy for rheumatic diseases: a systematic review.接受抗 TNF 治疗的风湿性疾病患者的结核病发病率:系统评价。
Clin Rheumatol. 2020 May;39(5):1439-1447. doi: 10.1007/s10067-019-04866-x. Epub 2020 Jan 3.
5
Ulcerative intestinal tuberculosis case as a complication of treatment by infliximab for intestinal Behçet's disease: A case report.溃疡性肠结核作为英夫利昔单抗治疗肠道白塞病的并发症:一例报告。
Medicine (Baltimore). 2019 Oct;98(43):e17652. doi: 10.1097/MD.0000000000017652.
6
High risk of tuberculosis during infliximab therapy despite tuberculosis screening in inflammatory bowel disease patients in India.尽管在印度对炎症性肠病患者进行了结核病筛查,但英夫利昔单抗治疗期间仍有高结核病风险。
Intest Res. 2018 Oct;16(4):588-598. doi: 10.5217/ir.2018.00023. Epub 2018 Oct 10.
7
Pleural Tuberculosis following Infliximab Therapy for Ankylosing Spondylitis.英夫利昔单抗治疗强直性脊柱炎后发生的胸膜结核
J Pharmacol Pharmacother. 2017 Jan-Mar;8(1):41-43. doi: 10.4103/jpp.JPP_174_16.
8
Misdiagnosis and Mistherapy of Crohn's Disease as Intestinal Tuberculosis: Case Report and Literature Review.克罗恩病误诊为肠结核的病例报告及文献复习
Medicine (Baltimore). 2016 Jan;95(1):e2436. doi: 10.1097/MD.0000000000002436.
9
TNF-alpha inhibitors for ankylosing spondylitis.用于强直性脊柱炎的肿瘤坏死因子-α抑制剂
Cochrane Database Syst Rev. 2015 Apr 18;2015(4):CD005468. doi: 10.1002/14651858.CD005468.pub2.