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

Falkenstern-Ge, R. F.; Husemann, K; Kohlhäufl, Martin

doi:10.1515/med-2015-0009

Cited by 4 publications

(3 citation statements)

References 15 publications

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“…To our knowledge, besides our case, 28 cases of a PR in miliary tuberculosis in non-HIV-infected patients have been reported in the past 40 years (Table 1) [[7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32]]. The manifestations described depended on the site of involvement.…”

Section: Discussionmentioning

confidence: 62%

Ground-glass opacity as a paradoxical reaction in miliary tuberculosis: A case report and review of the literature

Tokuyama

Matsumoto

Kusakabe

et al. 2020

IDCases

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A paradoxical reaction (PR) is an excessive immune response occurring during antitubercular therapy (ATT), but is rare in patients with miliary tuberculosis. A 78-year-old woman complained of general malaise, loss of appetite, and fever for 10 days. Chest computed tomography (CT) showed diffuse, bilateral, discrete miliary nodules. The patient was treated with ATT for miliary tuberculosis. Nine days after starting the treatment, she developed a spiking fever and worsening malaise. Repeat CT showed new localized ground-glass opacity (GGO) in the right upper lobe. After excluding possible etiologies, she was diagnosed with PR due to ATT. She was successfully managed with oral prednisolone while continuing ATT. The GGO diminished and did not recur after discontinuation of the steroids. We reviewed 28 reported cases of miliary tuberculosis with a PR in patients not infected with human immunodeficiency virus. Those not on immunosuppressive therapy were likely to develop a PR early. This case illustrates that a PR may present as localized GGO in miliary tuberculosis in the lung of patients treated with ATT. In cases of a PR with marked symptoms, steroid therapy may be valuable.

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Section: Discussionmentioning

confidence: 62%

Ground-glass opacity as a paradoxical reaction in miliary tuberculosis: A case report and review of the literature

Tokuyama

Matsumoto

Kusakabe

et al. 2020

IDCases

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“…A previous study showed that patients undergoing therapy with TNF-α-blockers are prone to develop TB infection. 33 Previous studies have shown that excessive TNF-α levels cause damage to the immune pathological response in cells and to protection of the body’s defense. 34 – 36 TNF-α levels may be related to the severity of the disease process and may serve as a parameter for predicting the prognosis of pulmonary TB.…”

Section: Discussionmentioning

confidence: 99%

Immunological recovery in patients with pulmonary tuberculosis after intensive phase treatment

Luo

Ma³

et al. 2018

J Int Med Res

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ObjectivesThis study aimed to examine the change and significance of immune parameters in patients with sputum smear-positive pulmonary tuberculosis (TB) after 2 months of intensive phase anti-TB treatment.MethodsThe immune parameters of 232 cases of sputum smear-positive pulmonary TB were detected before and after 2 months of intensive phase anti-TB treatment and compared with 50 cases from healthy volunteers (controls). The T lymphocyte cell population in peripheral blood was detected using flow cytometry. Serum levels of interleukin (IL)-1β, soluble interleukin-2 receptor, IL-6, and tumour necrosis factor-α were measured by ELISA.ResultsAfter 2 months of intensive phase anti-TB treatment, a reduction in the percentage of CD4+ T cells showed a significant restoration similar to that of controls. Moreover, after intensive anti-TB treatment, serum levels of IL-1β, soluble interleukin-2 receptor, IL-6, and tumour necrosis factor-α were significantly decreased compared with before treatment. Additionally, serum levels of IL-1β and IL-6 showed a diminished recovery compared with controls.ConclusionsOur findings suggest immunological recovery in patients with pulmonary TB after intensive phase treatment. Therefore, serum cytokine levels are considered potential host biomarkers for monitoring the response of treatment for pulmonary TB.

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“…It may seem paradoxical to treat TB-IRIS with TNF-I, given the known role of TNF-alpha in controlling mycobacterial infection [9]. However, several studies have shown that paradoxical reactions to antituberculosis treatment occur when TNF-I treatment is stopped [10][11][12]. Bana et al [6] showed that TNF-I discontinuation can lead to extended IRIS, particularly in cases of TB involving the lymph nodes.…”

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confidence: 99%

Tumor necrosis factor-alpha inhibitors for extended or severe neurological immune reconstitution inflammatory syndrome in HIV-infected patients

Laparra¹,

Lerolle²,

Gérin³

et al. 2021

Aids

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Tumor necrosis factor-alpha inhibitors for extended or severe neurological immune reconstitution inflammatory syndrome in HIV-infected patientsThe management of moderate-to-severe immune reconstitution inflammatory syndrome (IRIS) requires corticosteroid use in most symptomatic patients [1][2][3][4]. However, this treatment appears to be insufficient on its own in neurological IRIS, which is associated with a high mortality rate [2,5], and in persistent IRIS, exposing patients to a risk of long-term complications of corticosteroid use [6].Tumor necrosis factor-alpha inhibitors (TNF-I) are considered a useful option in cases of relapse or nonresponse to corticosteroids [7]. TNF-alpha plays a specific role in controlling mycobacterial infection and granuloma formation, but, at high levels, it may cause detrimental inflammation and increase the incidence of IRIS [8].We retrospectively collected data from six French HIV-1infected patients (Table 1) between March 2016 and August 2017. The median age of the patients was 38 years , and three of the patients were women. Five patients had bacteriological proven tuberculosis (TB), including two cases of neurological TB [e.g. TB with central nervous system (CNS) involvement]. One patient (number 6) had bacteriological proven cryptococcal meningitis.

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

Cited by 4 publications

References 15 publications

Ground-glass opacity as a paradoxical reaction in miliary tuberculosis: A case report and review of the literature

Ground-glass opacity as a paradoxical reaction in miliary tuberculosis: A case report and review of the literature

Immunological recovery in patients with pulmonary tuberculosis after intensive phase treatment

Tumor necrosis factor-alpha inhibitors for extended or severe neurological immune reconstitution inflammatory syndrome in HIV-infected patients

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