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Abstract
One of the severe adverse reactions to antitumor necrosis factor (TNF)-α therapy is the reactivation of tuberculosis. We present a case of tuberculous peritonitis in a 57-year- old woman with rheumatoid arthritis (RA) that appeared during treatment with infliximab. Confirming a diagnosis of tuberculous peritonitis is difficult and can be delayed because of the nonspecific symptoms, the rarity of the disease, and the low detection rate of mycobacteria in ascites fluid. This case illustrates that prompt anti-tuberculous therapy is needed for suspected cases of tuberculous peritonitis in RA patients treated with infliximab.
References
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Figure 1.
Computed tomographic finding. Omental and mesenteric fat infiltration with some nodular densities (arrows) and ascites (arrow head) were seen.
Table 1.
Tuberculosis peritonitis in TNF-α blocker using RA patients
| Patient No. | Age/Sex | Agent | Underlying disease | Diagnostic tool | Duration∗ (months) | Reference no. |
|---|---|---|---|---|---|---|
| 1 | 70/M | Infliximab | Ascites culture | 5 | 1 | |
| Peritoneal biopsy | ||||||
| 2 | 68/F | Infliximab | Ascites culture | 2 | ||
| Peritoneal biopsy | ||||||
| 3 | 53/F | Infliximab | Ascites culture | 3 | 2 | |
| 4 | 64/F | Infliximab | Ascites culture | 4.5 | 3 | |
| 5 | 71/F | Adalimumab | COPD† | Ascites culture | 18 | 4 |
| 6 | 56/F | Adalimumab | Hypothyroidism | Peritoneal biopsy | 12 | 5 |
| 7 | 73/F | Adalimumab | Peritoneal biopsy | 11 | 6 | |
| 8 | 19/F | Etanercept | JRA‡ | Ascites culture | 7 | |
| Peritoneal biopsy | 8 |
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