Ulcerative intestinal tuberculosis case as a complication of treatment by infliximab for intestinal Behçet's disease

Abstract

Rationale:Intestinal Behçet's disease (BD) is characterized by intestinal ulcerations and gastrointestinal symptoms. Ulcerative intestinal tuberculosis (TB) is usually with dyspepsia, abdominal pain, vomiting, and weight loss. The 2 diseases exhibit similar clinical manifestations, but the most critical aspects of their clinical courses and required treatments are not at all similar.Patient concerns:We present a case in which a patient with intestinal Behçet's disease developed a de novo ulcerative intestinal TB infection after the start of anti-tumor necrosis factor-α treatment. This was despite histopathologic examination without caseous necrosis granuloma and negative for acid-fast staining and latent TB screen.Diagnoses:Intestinal Behçet's disease and intestinal TB.Interventions:The patient was treated with quadruple antituberculous chemotherapy, comprising rifapentine, isoniazid, ethambutol, and pyrazinamide.Outcomes:At follow-up about 3 months, the therapy of oral antituberculous drugs and thalidomide was continued and the patient's condition had stabilized.Lessons:This case illustrates the importance of closely monitoring patients who are on infliximab for possible onset of TB, even without abdominal symptoms, and with negative screening results for latent TB.

Risk of tuberculosis is increased in Behçet’s disease compared to other rheumatological disorders after anti-TNFα treatments: a case series and review of the literature

“…As both BD and TB infection are common diseases in Turkey, TB data among TNF- antagonist treated patients deserve separate analysis. Apart from Turkey, a few case reports have been published in the literature on BD and TB coexistence [15][16][17][18]. In the series from Turkey, Kısacık et al showed that TB development rate was higher in BD compared to other rheumatic diseases (5/129, 4%).…”

Manifestaciones gastrointestinales de la enfermedad de Behçet

“…En áreas donde la tuberculosis y la EB son endémicas, se cree necesario considerar la tuberculosis intestinal como diagnóstico diferencial. Ya que, además de una sintomatología similar y afinidad por la región ileocecal, sus tratamientos difieren sustancialmente (2,33) . Y, para colmo, se han reportado casos de tuberculosis intestinal como complicación de la terapia biológica para EB, siendo entonces un diferencial a tener en cuenta tanto al momento del diagnóstico como en el seguimiento (33) .…”

“…Ya que, además de una sintomatología similar y afinidad por la región ileocecal, sus tratamientos difieren sustancialmente (2,33) . Y, para colmo, se han reportado casos de tuberculosis intestinal como complicación de la terapia biológica para EB, siendo entonces un diferencial a tener en cuenta tanto al momento del diagnóstico como en el seguimiento (33) . Dentro de las ayudas para diferenciar ambas entidades están la ausencia de compromiso extra intestinal en TB, la presencia de TB diseminada o pulmonar en el 50% de los casos, la presencia de fiebre (aunque no excluye EB debe hacer pensar como primera opción en TB) (6,34) .…”