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eISSN: 2084-9834
ISSN: 0034-6233
Reumatologia/Rheumatology
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5/2012
vol. 50
 
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abstract:
Case report

Tuberculosis in a patient with rheumatoid arthritis treated with infliximab

Bartosz Franiak
,
Magdalena Marek
,
Aleksandra Multan

Reumatologia 2012; 50, 5: 444–448
Online publish date: 2012/11/06
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Tumor necrosis factor α (TNF-α) plays a significant role in formation and stabilization of tuberculous granulomatous structures. That is why starting treatment with a TNF-α inhibitor increases tuberculosis morbidity. In developed countries it is usually a result of reactivation of latent infection. Hence proper diagnostics of latent tuberculosis infection, and starting chemoprophylaxis if necessary, is a standard procedure.

We report a case of a 60-year-old patient with rheumatoid arthritis who revealed pleurisy and pericarditis after treatment with infliximab (Fig. 1). After starting anti-tuberculosis therapy the patient’s condition improved and changes in X-ray images disappeared.

Rheumatoid arthritis was treated with leflunomide for one year, then thoracic X-ray was performed and revealed changes described as fibro-cavernous tuberculosis (Fig. 2). Despite negative bacteriological test results, anti-tuberculosis treatment was repeated.

The article presents the advantages and disadvantages of skin tuberculin test and IGRA tests (interferon- release assay), highlighting the important role of the IGRA test in diagnostics of latent tuberculosis infections.

The paper proposes differential diagnostics which need to be carried out in case of the described clinical and radiological picture.
keywords:

tuberculosis, IGRA, tumor necrosis factor α antagonists







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