Unusual manifestation of tuberculosis in an ulcerative colitis patient treated with infliximab


Authors: Dombrovská K. 1;  Hrabovský V. 1,2;  Štefaňáková Z. 1;  Škrobánková M. 1,2;  Svoboda P. 1,2
Published in: Gastroent Hepatol 2019; 73(4): 339-344
Category:
doi: 10.14735/amgh2019339

Overview

Tumor necrosis factor alpha (TNF-α) inhibitors are very potent treatments for ulcerative colitis (UC). However, infectious complications, including tuberculosis (TB), are a major risk with these medications. This study aimed to present a case report of a TB patient treated with infliximab (IFX) and to summarize recent information about TB in the Czech Republic. A refractory UC patient treated with IFX was repeatedly hospitalized due to infectious complications. Following extensive differential diagnosis, TB infection with predominant brain involvement was diagnosed. The major cause of TB infection during anti-TNF (a-TNF) therapy is probably reactivation of the latent form. TNF plays an essential role in the pathogenesis of TB infection, and the host immune system fails when TNF is blocked. Therefore, TB usually develops soon after initiation of a-TNF therapy, and prophylactic antituberculotic treatment is often ineffective. The extrapulmonary form is more common than the pulmonary form. TB is an important complication of a-TNF treatment. Preventive examinations prior to initiation of a-TNF therapy only reduce the disease incidence. One possible solution is consistent implementation or further tightening of professional guidelines.

Doručeno/Submitted: 24. 3. 2019

Přijato/Accepted: 18. 6. 2019

 

MUDr. Martina Škrobánková

Interní klinika LF OU a FN Ostrava

17. listopadu 1790

708 00 Ostrava-Poruba

martinaskrobankova@email.cz

Keywords:

ulcerative colitis – tuberculosis – infliximab


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Paediatric gastroenterology Gastroenterology and hepatology Surgery

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