PSEUDOTUMORAL TUBERCULOSIS AFTER 13 MONTHS OF ADALIMUMAB. CASE REPORT

Authors

  • Cristina CIOTI “Ovidius” University of Constanta
  • I.A. ARGHIR “Ovidius” University of Constanta
  • Emma GHEORGHE “Ovidius” University of Constanta
  • Enis BEITULA “Ovidius” University of Constanta
  • Ileana ION “Ovidius” University of Constanta
  • Paraschiva POSTOLACHE “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Abstract

In patients with chronic immune-mediated inflammatory diseases, biological therapy targeting the components of the immune response acts like suppressive agents of the host immune system, being associated with increased risk of opportunistic infections and tuberculosis (TB). The case of a 35-year-old male patient, active smoker, with chronic psoriasis, previously treated for 13 months with the tumor necrosis factor α (TNF-α) inhibitor adalimumab is reported. The patient was admitted for a peripheral lung mass localized in the left upper lobe, associated with mediastinal lymphadenopathy, highly suggestive of lung cancer. Sputum smears and bronchoalveolar lavage were negative for acid fast bacilli, but tuberculin skin test (TST) results converted from negative to positive in the last 13 months. Histological description of lymph node biopsy revealed sarcoidosis. Due to the discrepancy between positive TST, imaging and histological results, surgical open lung biopsy was considered. Atypical segmental resection was performed, and the final histological diagnosis was TB. In conclusion, all patients with autoimmune diseases should be screened for the presence of latent TB infection (LTBI) before starting biologic therapy, and periodically monitored for active TB disease, which can be atypical because of immunosuppression.

Author Biographies

  • Cristina CIOTI, “Ovidius” University of Constanta

    Faculty of Medicine
    Department of Internal Medicine

  • I.A. ARGHIR, “Ovidius” University of Constanta

    Faculty of Medicine
    Department of Internal Medicine

  • Emma GHEORGHE, “Ovidius” University of Constanta

    Faculty of Medicine
    Department of Internal Medicine

  • Enis BEITULA, “Ovidius” University of Constanta

    Faculty of Medicine
    Department of Internal Medicine

  • Ileana ION, “Ovidius” University of Constanta

    Faculty of Medicine
    Department of Internal Medicine

  • Paraschiva POSTOLACHE, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

    Faculty of Medicine
    Department of Medical Specialties (I)
    Clinical Rehabilitation Hospital / Pulmonary Rehabilitation Clinic, Iasi

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Additional Files

Published

2020-06-30

Issue

Vol. 124 No. 2 (2020): The Medical-Surgical Journal

Section

INTERNAL MEDICINE - PEDIATRICS

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