原创力文档A patient with de novo tuberculosis during anti-tumor necrosis factor-alpha therapy illustrating.pdf
- 1、本文档共6页，可阅读全部内容。
- 2、原创力文档（book118）网站文档一经付费（服务费），不意味着购买了该文档的版权，仅供个人/单位学习、研究之用，不得用于商业用途，未经授权，严禁复制、发行、汇编、翻译或者网络传播等，侵权必究。
- 3、本站所有内容均由合作方或网友上传，本站不对文档的完整性、权威性及其观点立场正确性做任何保证或承诺！文档内容仅供研究参考，付费前请自行鉴别。如您付费，意味着您自己接受本站规则且自行承担风险，本站不退款、不进行额外附加服务；查看《如何避免下载的几个坑》。如果您已付费下载过本站文档，您可以点击 这里二次下载。
- 4、如文档侵犯商业秘密、侵犯著作权、侵犯人身权等，请点击“版权申诉”（推荐），也可以打举报电话：400-050-0827(电话支持时间：9:00-18:30)。
查看更多
A patient with de novo tuberculosis during anti-tumor necrosis factor-alpha therapy illustrating
1470 ? CID 2007:45 (1 December) ? Arend et al.
V I E W P O I N T S
A Patient with De Novo Tuberculosis during Anti–Tumor
Necrosis Factor–a Therapy Illustrating Diagnostic Pitfalls
and Paradoxical Response to Treatment
Sandra M. Arend,1 Eliane M. S. Leyten,1 Willeke P. J. Franken,1 Erik M. Huisman,2 and Jaap T. van Dissel1
1Department of Infectious Diseases, Leiden University Medical Center, Leiden, and 2Municipal Health Service, The Hague, The Netherlands
In 2005, a 24-year-old man with Crohn disease who had been treated with infliximab for several months was exposed to an
individual with smear-positive tuberculosis. Soon after exposure, he complained of malaise, dry cough, and weight loss.
Despite normal chest radiograph findings and negative tuberculin skin test results, tuberculosis was considered to be the
most likely diagnosis. The results of a whole-blood assay for detection of interferon-g production in response to Mycobacterium
tuberculosis–specific antigen were positive. Acid-fast staining and polymerase chain reaction of bronchoalveolar lavage fluid
samples had negative results, but M. tuberculosis was cultured. After the initiation of 4 antitubercular drugs and the dis-
continuation of infliximab therapy, the patient developed an immune reconstitution syndrome accompanied by enlarged
mediastinal lymph nodes and multiple intrapulmonary miliary lesions. This case of de novo tuberculosis during anti–tumor
necrosis factor a treatment illustrates the uncharacteristic presentation of the disease and the elusiveness of the diagnosis,
as well as the fact that discontinuation of anti–tumor necrosis factor a treatment can be accompanied by an immune
reconstitution syndrome similar to that observed in human immunodeficiency virus–infected individuals with tuberculosis.
Received 7 May 2007; accepted 13 July 2007;
electronically published 25 October 2007.
Presented in part: Rethinking the Epidemiology of
Tuberculosis Infection—The First Global Symposium on
Interferon-
文档评论（0）