Open AccessUlcerative intestinal tuberculosis case as a complication of treatment by infliximab for intestinal Behçet's disease
Author(s) -
Siyu Yan,
Hui Ma,
Yanli Yang,
Jian-Long Guan
Publication year - 2019
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000017652
Subject(s) - medicine , infliximab , pyrazinamide , ethambutol , latent tuberculosis , gastroenterology , behcet's disease , tuberculosis , ulcerative colitis , rifapentine , adalimumab , isoniazid , surgery , disease , mycobacterium tuberculosis , pathology
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.