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Yoo, Roh, Park, Kim, Jang, Na, and Shim: A Case of Miliary Tuberculosis in a Patient with Behcet's Disease and Uveitis Receiving Infliximab
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2009; 67(5): 454-457.

Published online: 30 November 2009

DOI: https://doi.org/10.4046/trd.2009.67.5.454

A Case of Miliary Tuberculosis in a Patient with Behcet's Disease and Uveitis Receiving Infliximab

Jung-Wan Yoo, M.D., Jae Hyung Roh, M.D., Jin Wook Park, M.D., Yong Giun Kim, M.D., Ji Woong Jang, M.D., Soo Young Na, M.D., Tae Sun Shim, M.D.

Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

Address for correspondence: Tae Sun Shim, M.D. Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1, Pungnap-dong, Songpa-gu, Seoul 138-736, Korea. Phone: 82-2-3010-3892, Fax: 82-2-3010-6968, shimts@amc.seoul.kr

Received 14 July 2009       Accepted 23 September 2009

Copyright©2009. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

Infliximab, a TNF-α antagonist, has been used to treat refractory rheumatoid arthritis, ankylosing spondylitis, Crohn's disease and Behcet's disease. Tuberculosis (TB) is a well-known opportunistic infection in patients receiving infliximab. Therefore, patients should be screened and treated for latent or active TB infection before being administered infliximab. Recently, we encountered a case of military TB during infliximab therapy in a patient suffering from Behcet's disease and uveitis. We report this case with a review of the relevant literature.

Keywords: Tumor Necrosis Factor-alpha, Infliximab, Tuberculosis, Miliary

Figures and Tables

Figure 1
(A) Chest radiography shows multiple nodular opacity on both lungs. (B) Chest CT scan reveals even distribution of about 3 mm multiple nodules on both lungs.
trd-67-454-g001
Figure 2
Lung tissue shows granuloma and central caseous necrosis (H&E stain, ×100).
trd-67-454-g002

References

1. Turan B, Gallati H, Erdi H, Gurler A, Michel BA, Villiger PM. Systemic levels of the T cell regulatory cytokines IL-10 and IL-12 in Bechcet's disease; soluble TNFR-75 as a biological marker of disease activity. J Rheumatol. 1997. 24:128–132.
2. Niccoli L, Nannini C, Benucci M, Chindamo D, Cassara E, Salvarani C, et al. Long-term efficacy of infliximab in refractory posterior uveitis of Behcet's disease: a 24-month follow-up study. Rheumatology (Oxford). 2007. 46:1161–1164.
3. Seong SS, Choi CB, Woo JH, Bae KW, Joung CL, Uhm WS, et al. Incidence of tuberculosis in Korean patients with rheumatoid arthritis (RA): effects of RA itself and of tumor necrosis factor blockers. J Rheumatol. 2007. 34:706–711.
4. Accorinti M, Pirraglia MP, Paroli MP, Priori R, Conti F, Pivetti-Pezzi P. Infliximab treatment for ocular and extraocular manifestations of Behcet's disease. Jpn J Ophthalmol. 2007. 51:191–196.
5. Wallis RS, Broder MS, Wong JY, Hanson ME, Beenhouwer DO. Granulomatous infectious diseases associated with tumor necrosis factor antagonists. Clin Infect Dis. 2004. 38:1261–1265.
6. Balcewicz-Sablinska MK, Keane J, Kornfeld H, Remold HG. Pathogenic Mycobacterium tuberculosis evades apoptosis of host macrophages by release of TNF-R2, resulting in inactivation of TNF-alpha. J Immunol. 1998. 161:2636–2641.
7. Wagner TE, Huseby ES, Huseby JS. Exacerbation of Mycobacterium tuberculosis enteritis masquerading as Crohn's disease after treatment with a tumor necrosis factor-alpha inhibitor. Am J Med. 2002. 112:67–69.
8. Wolfe F, Michaud K, Anderson J, Urbansky K. Tuberculosis infection in patients with rheumatoid arthritis and the effect of infliximab therapy. Arthritis Rheum. 2004. 50:372–379.
9. Lee YS, Jung JO, Hong JH, Seo YI, Eom KS, Jang SH, et al. Occurrence of tuberculous pleurisy associated with infliximab therapy. Korean J Med. 2004. 67:421–424.
10. Kim YH, Lee BJ, Park JJ, Lee WW, Han WS, Oh SN, et al. Tuberculous meningitis in a patient with Crohn's disease, which was treated with infliximab. Korean J Gastrointest Endosc. 2007. 34:339–342.
11. British Thoracic Society Standards of Care Committee. BTS recommendations for assessing risk and for managing Mycobacterium tuberculosis infection and disease in patients due to start anti-TNF-alpha treatment. Thorax. 2005. 60:800–805.
12. Sichletidis L, Settas L, Spyratos D, Chloros D, Patakas D. Tuberculosis in patients receiving anti-TNF agents despite chemoprophylaxis. Int J Tuberc Lung Dis. 2006. 10:1127–1132.
13. Ruderman EM, Markenson J. Granulomatous infections and tumor necrosis factor antagonist therapies: update through. Arthritis Rheum. 2002. 48:S241.
14. Miyasaka N, Takeuchi T, Eguchi K. Proposed Japanese guidelines for the use of infliximab for rheumatoid arthritis. Mod Rheumatol. 2006. 15:4–8.
15. Wallis RS, van Vuuren C, Potgieter S. Adalimumab treatment of life-threatening tuberculosis. Clin Infect Dis. 2009. 48:1429–1432.
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