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Oral tuberculosis associated with a treatment with anti‐rheumatic drugs
Author(s) -
Kolokotronis Alexandros,
Avramidou Evanda,
Zaraboukas Thomas,
Mandraveli Kalliopi,
Alexiou Stella,
Antoniades Demetrios
Publication year - 2006
Publication title -
journal of oral pathology and medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.887
H-Index - 83
eISSN - 1600-0714
pISSN - 0904-2512
DOI - 10.1111/j.1600-0714.2006.00363.x
Subject(s) - medicine , adalimumab , rheumatoid arthritis , tuberculosis , lesion , infliximab , methotrexate , granuloma , dermatology , mycobacterium tuberculosis , arthritis , gastroenterology , surgery , immunology , disease , pathology
Background: The use of immunosuppressive medication is a dominant risk factor for infection in patients with rheumatoid arthritis (RA). Methotrexate (MTX) is one of the traditional disease‐modifying antirheumatic drugs. Adalimumab [a human anti‐tumor necrosis factor‐ α (anti‐TNF‐ α ) monoclonal antibody] represent an important advance in the treatment of RA and has been recently come in use. TNF‐ α plays a role in the host defense against Mycobacterium tuberculosis and notably in granuloma formation. Infections occur at a high rate among those who use one or the combination of the two medications. Method: We examined a female patient that was referred to our department for evaluation and treatment of a granular lesion on the soft palate and uvula, complaining of mild dysphagia. The patient was treated for 4 months with MTX and adalimumab for RA before the oral lesion appeared. Results: The histopathological examination of a specimen of the oral lesion, taken by biopsy, showed a chronic inflammation characterized by tuberculous granulomas. Polymerase chain reaction test and culture of a new specimen was positive for M. tuberculosis . Conclusions: The therapeutic use of MTX or/and adalimumab for the treatment of RA or few others diseases, can cause oral tuberculosis.