RESUMO
A 67-year-old man presented with fever, night sweat and abdominal complaints for about 4 weeks. Ultrasound and a computed tomography scan showed distinct ascites as the main finding, presenting as exsudate with predominating lymphoid cells. Because of long-term immunosuppressive therapy with the tumor necrosis factor (TNF)-α inhibitor golimumab for psoriasis, the suspicion for a possible tuberculous peritonitis arose. This was confirmed with an enzyme-linked immunospot assay, a high level of adenosine deaminase in the ascites and a peritoneum which was studded with multiple whitish nodules, corresponding to granulomas with giant cells. With a standard antituberculous regimen the symptoms were quickly relieved and finally complete restitution was achieved.
Assuntos
Anticorpos Monoclonais/efeitos adversos , Ascite/etiologia , Febre de Causa Desconhecida/etiologia , Peritonite Tuberculosa/induzido quimicamente , Psoríase/tratamento farmacológico , Sudorese , Adenosina Desaminase/metabolismo , Idoso , Anticorpos Monoclonais/uso terapêutico , Ritmo Circadiano , Diagnóstico Diferencial , ELISPOT , Humanos , Masculino , Peritonite Tuberculosa/diagnósticoRESUMO
Opportunistic infection and reactivation of latent infection has been reported with use of monoclonal TNF alpha antibodies used for treatment of severe rheumatoid arthritis. We present a case of peritoneal tuberculosis (TB) causing renal failure secondary to ureteral constriction in a patient who had been treated with infliximab for rheumatoid arthritis. We suggest that physicians should be aware of the increased risk of false negative and false positive TST and IGRA among patients treated with monoclonal TNF alpha antibodies and should regularly look for usual and unusual symptoms of TB in this patient population.
Assuntos
Injúria Renal Aguda/etiologia , Anticorpos Monoclonais/efeitos adversos , Antirreumáticos/efeitos adversos , Artrite Reumatoide/tratamento farmacológico , Peritonite Tuberculosa/complicações , Idoso , Artrite Reumatoide/complicações , Feminino , Humanos , Infliximab , Peritonite Tuberculosa/induzido quimicamente , Obstrução Ureteral/complicaçõesRESUMO
A case of multiple organ tuberculosis (TBc) involving lung, pleura, and peritoneum in a 39-year-old man with long-standing ankylosing spondylitis (AS) treated with adalimumab was presented. The relationship between antitumor necrosis factor-α (anti-TNF-α) therapy and TBc was also reviewed. This case illustrates that TBc can develop in multiple organs during adalimumab therapy, and thus, the awareness of serious complications of multiple organs and atypical extrapulmonary pattern of TBc during anti-TNF-α therapy needs to be increased.