Open AccessDisseminated Tuberculosis Associated With Adalimumab Therapy
Author(s) -
Marinha Silva,
Joana Braga,
Cristiana Fernandes,
Jose Miguel Ferreira,
Cristina Marques,
Carina Costa Silva,
Carla Lemos Costa
Publication year - 2021
Publication title -
journal of medical cases
Language(s) - Uncategorized
Resource type - Journals
eISSN - 1923-4163
pISSN - 1923-4155
DOI - 10.14740/jmc3723
Subject(s) - medicine , adalimumab , latent tuberculosis , tuberculosis , immunosuppression , anorexia , immunology , pediatrics , rheumatoid arthritis , mycobacterium tuberculosis , pathology
Therapeutic blockade of tumour necrosis factor alpha (anti-TNF-α) is the mainstay treatment of several rheumatologic diseases. They are unfrequently associated with opportunistic infections and latent tuberculosis (TB) screening is paramount before immunosuppression. A 62-year-old man with psoriatic arthritis was under treatment with adalimumab for over 5 years. The screening for latent tuberculosis infection (LTBI) prior to the start of immunosuppression was negative, and a subsequent interferon gamma release assay 4 years later was also negative. He presented in the emergency department complaining of asthenia, anorexia, fever, night sweats and weight loss for over 5 months. He also complained of memory loss, despite his normal cognitive and neurological examination. After an exhaustive workup, he was diagnosed with a disseminated tuberculosis (cerebral, pulmonary and peritoneal) and treated accordingly. TB diagnosis remains challenging in certain situations. Latent TB screening tests may lack sensitivity and immunosuppressive therapy increases the risk of disseminated infection. We discuss the workup and management of a central nervous system disseminated TB related to adalimumab therapy.