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NAOSITE Nagasaki Universitys Academic Output SITE.pdf

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Title report Author(s) Kohno, Shigeru Citation BMC Infectious Diseases, 14(1), 114; 2014 Issue Date 2014-02-28 URL /10069/34298 Right Public Domain Dedication waiver http://naosite.lb.nagasaki-u.ac.jp Takazono et al. BMC Infectious Diseases 2014, 14:114 /1471-2334/14/114 CASE REPORT Open Access Paradoxical response to disseminated non-tuberculosis mycobacteriosis treatment in a patient receiving tumor necrosis factor-α inhibitor: a case report 1 1* 1 1 1 Takahiro Takazono , Shigeki Nakamura , Yoshifumi Imamura , Taiga Miyazaki , Koichi Izumikawa , Hiroshi Kakeya1,3, Katsunori Yanagihara2 and Shigeru Kohno1 Abstract Background: Biological agents such as tumor necrosis factor-α inhibitors are known to cause mycobacterium infections. Here, we report a disseminated non-tuberculosis case caused by TNF-α inhibitor therapy and a probable paradoxical response to antimycobacterial therapy. Case presentation: A 68-year-old man with relapsing polychondritis was refractory to glucocorticoid therapy; adalimumab was therefore administered in combination with oral glucocorticoids. Treatment with 40 mg of adalimumab led to rapid improvement of his clinical manifestations. The administration of tacrolimus (1 mg) was started as the dosage of oral glucocorticoids was tapered. However, the patient developed an intermittent high fever and productive cough 15 months after starting adalimumab treatment. A chest computed tomography scan revealed new granular shadows and multiple nodules in both lung fields with mediastinal lymphadenopathy, and Mycobacterium intracellulare was isolated from 2 sput