有哪些信誉好的足球投注网站A patient with de novo tuberculosis during anti-tumor necrosis factor-alpha therapy illustrating.pdf
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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-
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