Vol.62 No.6 November 2014
Three cases of active tuberculosis in patients receiving anti-TNF (tumor necrosis factor) agents despite treatment for latent tuberculosis infection
1)Department of Infectious Disease and Infection Control, The Jikei University Katsushika Medical Center, 6-41-2 Aoto, Tokyo, Japan
2)Department of Infectious Disease and Infection Control, Jikei University School of Medicine
3)Department of Infectious Disease and Infection Control, The Jikei University Daisan Hospital
4)Department of Infectious Disease and Infection Control, The Jikei University Kashiwa Hospital
5)Department of Respiratory Medicine, The Jikei University Katsushika Medical Center
Abstract
We report herein on three cases of active tuberculosis in patients receiving anti-tumor necrosis factor(TNF) agents despite treatment for latent tuberculosis infection(LTBI).
The first case was a 37-year-old man with Crohn's disease. He had a positive result on the interferon gamma release assay(IGRA) and chest computed tomography(CT) scan showed trabecular shadows that suggest old pulmonary tuberculosis in the bilateral upper lobes and the right middle lobe when LTBI was diagnosed. Infliximab was administered, at 49 days after LTBI treatment with isoniazid(INH) 300 mg/day. The LTBI treatment was continued after the course for six months, but the compliance with the INH was unknown. The patient was diagnosed as having pulmonary tuberculosis at 28 months after starting infliximab treatment. INH resistant Mycobacterium tuberculosis was detected in the gastric juice. The second case was a 51-year-old woman with rheumatoid arthritis(RA). She had a positive result on the IGRA and chest CT scan showed trabecular shadows in the right upper and middle lobes when LTBI was diagnosed. Etanercept was administered, at 48 days after LTBI treatment with INH 300 mg/day. The LTBI treatment was performed for six months. The patient was diagnosed as having cervical tuberculous lymphadenitis six months after the cessation of the LTBI treatment. The third case was a 39-year-old woman with RA. A tuberculin skin test was positive and chest CT scan showed a trabecular shadow in the left lower lobe when LTBI was diagnosed. She was started on LTBI treatment with INH 300 mg/day, then developed mild liver dysfunction. After the INH dose was reduced to 200 mg/day, infliximab was administered. The patient was diagnosed as having pulmonary tuberculosis four months after starting infliximab treatment. We should pay attention to active tuberculosis during the administration of anti-TNF agents even if LTBI treatment has been performed, and we need to monitor INH compliance carefully. LTBI treatment should be performed appropriately.
Key word
isoniazid, tuberculosis, tumor necrosis factor (TNF), infliximab, etanercept
Received
June 2, 2014
Accepted
August 27, 2014
Jpn. J. Chemother. 62 (6): 681-686, 2014
