Prolonged paradoxical response to anti-tuberculous treatment after infliximab

Melboucy‐Belkhir, Sara; Flexor, G.; Stirnemann, Jérôme; Morin, Anne‐Sophie; Boukari, L.; Polliand, C.; Cruaud, P.; Fain, Olivier

doi:10.1016/j.ijid.2010.03.002

Cited by 20 publications

(11 citation statements)

References 8 publications

(16 reference statements)

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“…Discontinuing anti-TNF therapy during treatment for TB sometimes results in the reconstitution of the immune system and may contribute to "paradoxical worsening." This phenomenon, known as immune reconstitution inflammatory syndrome (IRIS), is well recognized in human immunodeficiency virus (HIV) patients treated with anti-TB and anti-HIV therapy (2).…”

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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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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“…As a result, prednisone was started, which had a good effect. Although paradoxical reactions are well described in the treatment of tuberculosis (Melboucy-Belkhir et al, 2010), almost no case reports on non-tuberculous mycobacteria (NTM) are available. Theoretically, a similar paradoxical response as seen in tuberculosis could be expected in the treatment of NTM as well.…”

Section: Discussionmentioning

confidence: 99%

Dissemination of localized Mycobacterium malmoense infection in an immunocompromised patient

Zweijpfenning

Schipper

Duurkens

et al. 2018

International Journal of Infectious Diseases

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A 75-year-old woman with a history of immunosuppressive treatment for rheumatoid arthritis and non-Hodgkin lymphoma, was referred to our reference centre for treatment of tenosynovitis caused by Mycobacterium malmoense, which had disseminated due to immunosuppressive therapy. This rare diagnosis was made after years of treatment for supposed rheumatoid arthritis. The patient presented with relapsing tenosynovitis with wounds on her right middle finger and wounds on her left lower leg, despite 3 months of adequate therapy (rifampicin+ethambutol+clarithromycin). Therapy was intensified with amikacin, clofazimine, moxifloxacin, and interferon-gamma due to the lack of response. Amputation of the right middle finger was necessary due to advanced disease. Treatment was further complicated by a paradoxical reaction, requiring prednisone treatment, which ultimately led to cure.

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“…HIV- negative patients could develop a severe prolonged paradoxical reaction under the ongoing tuberculosis therapy. Based on the review of the literature, patients with discontinuation of the regular treatment with TNF- alpha–blockers do have a higher risk to develop an unexpected prolonged paradoxical reaction with a severe and also fatal outcome during tuberculosis therapy [3–5]. …”

Section: Discussionmentioning

confidence: 99%

“…HIV- positive patients are prone to immune reconstitution inflammatory syndrome IRIS with a severe and also fatal outcome during tuberculosis therapy [3–5]. In literature, cases in which patients develop prolonged paradoxical reaction under tuberculosis therapy remain extremely rare [3–5].…”

Section: Discussionmentioning

confidence: 99%

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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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Prolonged paradoxical response to anti-tuberculous treatment after infliximab

Cited by 20 publications

References 8 publications

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

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

Dissemination of localized Mycobacterium malmoense infection in an immunocompromised patient

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

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