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Disseminated Tuberculosis Associated With Adalimumab Therapy. | LitMetric

AI Article Synopsis

  • Anti-TNF-α therapy, like adalimumab, is commonly used to treat various rheumatologic diseases, but it can increase the risk of opportunistic infections, making latent tuberculosis screening essential before starting treatment.
  • A 62-year-old man with psoriatic arthritis was treated with adalimumab and initially tested negative for latent tuberculosis; however, he later experienced symptoms of systemic infection and was diagnosed with disseminated tuberculosis affecting multiple organs, including the brain.
  • The case highlights the difficulties in diagnosing tuberculosis, especially in patients on immunosuppressive therapy, and emphasizes the need for careful monitoring and management.

Article Abstract

Therapeutic blockade of tumour necrosis factor alpha (anti-TNF-α) is the mainstay treatment of several rheumatologic diseases. They are unfrequently associated with opportunistic infections and latent tuberculosis (TB) screening is paramount before immunosuppression. A 62-year-old man with psoriatic arthritis was under treatment with adalimumab for over 5 years. The screening for latent tuberculosis infection (LTBI) prior to the start of immunosuppression was negative, and a subsequent interferon gamma release assay 4 years later was also negative. He presented in the emergency department complaining of asthenia, anorexia, fever, night sweats and weight loss for over 5 months. He also complained of memory loss, despite his normal cognitive and neurological examination. After an exhaustive workup, he was diagnosed with a disseminated tuberculosis (cerebral, pulmonary and peritoneal) and treated accordingly. TB diagnosis remains challenging in certain situations. Latent TB screening tests may lack sensitivity and immunosuppressive therapy increases the risk of disseminated infection. We discuss the workup and management of a central nervous system disseminated TB related to adalimumab therapy.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8425810PMC
http://dx.doi.org/10.14740/jmc3723DOI Listing

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