Life-threatening disseminated tuberculosis as a complication of TNF-α blockade in an adolescent

Hess, Steffen; Hospach, Toni; Nossal, Robert; Dannecker, Günther; Magdorf, K.; Uhlemann, Frank

doi:10.1007/s00431-011-1501-y

Cited by 24 publications

(15 citation statements)

References 32 publications

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“…A minority of patients may present with symptoms of less than four weeks duration. An underlying predisposing condition such as diabetes or steroid use will be present in about a third of patients [16] and immunosuppression due to HIV or iatrogenic reasons may also contribute [17]. The CXR may be initially normal for the first few weeks of the disease.…”

Section: Reasons and Outcome For Icu Admission In Tuberculosis Patientsmentioning

confidence: 99%

“…This is usually described in association with HIV infection [19], and recently associated with monoclonal antibodies used in the treatment of rheumatological disease [17], but can also occur in patients with no obvious risk factors [20]. Disseminated TB may also cause adrenal insufficiency [21], which should be considered in the context of refractory hypotension or hyponatraemia.…”

Section: Reasons and Outcome For Icu Admission In Tuberculosis Patientsmentioning

confidence: 99%

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Clinical review: Tuberculosis on the intensive care unit

Hagan

Nathani

2013

Critical Care

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Rates of tuberculosis (TB) are increasing in most west European nations. Patients with TB can be admitted to an ICU for a variety of reasons, including respiratory failure, multiorgan failure and decreased consciousness associated with central nervous system disease. TB is a treatable disease but the mortality for patients admitted with TB to an ICU remains high. Management challenges exist in establishing a prompt diagnosis and administering effective treatment on the ICU with potentially poor gastric absorption and high rates of organ dysfunction and drug toxicity. In this review reasons for ICU admission, methods of achieving a confident diagnosis through direct and inferred methods, anti-tuberculosis treatment (including steroid and other adjuvant therapies) and specific management problems with particular relevance to the intensivist are discussed. The role of therapeutic drug monitoring, judicious use of alternative regimes in the context of toxicity or organ dysfunction and when to suspect paradoxical tuberculosis reactions are also covered. Diagnostic and therapeutic algorithms are proposed to guide ICU doctors in the management of this sometimes complicated disease.

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Section: Reasons and Outcome For Icu Admission In Tuberculosis Patientsmentioning

confidence: 99%

Section: Reasons and Outcome For Icu Admission In Tuberculosis Patientsmentioning

confidence: 99%

Clinical review: Tuberculosis on the intensive care unit

Hagan

Nathani

2013

Critical Care

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“…Anti-tumor necrosis factor (TNF) therapy increases the risk of tuberculosis (TB) (1). Discontinuing anti-TNF therapy during treatment for TB sometimes results in the reconstitution of the immune system and may contribute to "paradoxical worsening."…”

Section: Introductionmentioning

confidence: 99%

Central Nervous System Manifestations of Tuberculosis-associated Immune Reconstitution Inflammatory Syndrome during Adalimumab Therapy: A Case Report and Review of the Literature

et al. 2015

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A 64-year-old neurologically asymptomatic woman with rheumatoid arthritis who was treated with the tumor necrosis factor (TNF)-α antagonist adalimumab developed disseminated tuberculosis (TB). After receiving anti-TB therapy and discontinuing adalimumab, she exhibited paradoxical worsening due to immune reconstitution inflammatory syndrome (IRIS) with the appearance of meningitis and brain tuberculomas. This case indicates that continuing anti-TNF therapy may be necessary to prevent IRIS in patients who develop TB, particularly disseminated TB, during the course of anti-TNF therapy. In addition, careful screening for central nervous system (CNS) TB should be performed prior to the initiation of therapy, as even neurologically asymptomatic patients can develop CNS manifestations of IRIS.

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“…Due to the central role of TNF- alpha in host defense mechanisms, TNF antagonist can increase patients’ susceptibility to various kinds of infections, especially those requiring granuloma formations [6,7]. Several studies have shown that all currently available TNF blockers carry an increased risk for the development of active tuberculosis [8–11].…”

Section: Discussionmentioning

confidence: 99%

Prolonged paradoxical reaction to antituberculous treatment after discontinuation of TNF-alpha- blocker therapy with adalimumab. Rare clinical documentation

Falkenstern-Ge¹,

Husemann

Kohlhäufl

2014

Open Medicine

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AbstractIn the past decades, tumor necrosis factor alpha (TNF-a) antagonist has been a milestone in the treatment of many chronic inflammatory diseases. TNF antagonist can increase patients´ susceptibility to many different kinds of infections especially those requiring granuloma formations despite regular performance of Screening for latent tuberculosis infection (LTBI). We report 2 cases of patients who developed tuberculosis under treatment with adalimumab, which was discontinued after the diagnosis of tuberculosis. During the tuberculosis therapy they unexpectedly developed a prolonged paradoxical reaction. In both cases we were only able to manage the progress of the paradoxical reaction through high steroid doses. Patients undergoing therapy with TNF- alphablocker are prone to develop tuberculosis infection, which could in turn lead to severe prolonged paradoxical reaction during anti-tuberculous treatment. An increased steroid dose may be required and is sometimes necessary

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Life-threatening disseminated tuberculosis as a complication of TNF-α blockade in an adolescent

Cited by 24 publications

References 32 publications

Clinical review: Tuberculosis on the intensive care unit

Clinical review: Tuberculosis on the intensive care unit

Central Nervous System Manifestations of Tuberculosis-associated Immune Reconstitution Inflammatory Syndrome during Adalimumab Therapy: A Case Report and Review of the Literature

Prolonged paradoxical reaction to antituberculous treatment after discontinuation of TNF-alpha- blocker therapy with adalimumab. Rare clinical documentation

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