The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

A Case of Multiple Tuberculosis Associated with Infliximab Therapy in Crohn's Disease

크론병 환자에서 Infliximab 치료 후 발생한 중증 다발성 결핵 1예

  • Kim, Hee-Wook (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Jang, Sung-Ill (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Kim, Bun (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Youn, Young-Hoon (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Byun, Min-Kwang (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Park, Hyo-Jin (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Lee, Sang-In (Department of Internal Medicine, Yonsei University College of Medicine)
  • 김희욱 (연세대학교 의과대학 내과학교실) ;
  • 장성일 (연세대학교 의과대학 내과학교실) ;
  • 김번 (연세대학교 의과대학 내과학교실) ;
  • 윤영훈 (연세대학교 의과대학 내과학교실) ;
  • 변민광 (연세대학교 의과대학 내과학교실) ;
  • 박효진 (연세대학교 의과대학 내과학교실) ;
  • 이상인 (연세대학교 의과대학 내과학교실)
  • Published : 2012.09.01
⟨ Previous Next ⟩

Abstract

Infliximab, a tumor necrosis $factor-{\alpha}$($TNF-{\alpha}$) inhibitor, has been approved for the treatment of a variety of inflammatory illnesses, including Crohn's disease. However, infliximab can increase the risk of reactivation of latent tuberculosis (Tbc) infection by affecting host immune responses. Therefore, a screening test should be performed before the initiation of infliximab therapy, and patients with evidence of latent infection should be treated with prophylactic anti-Tbc therapy. Here, we report a case of multifocal disseminated tuberculosis after treatment with infliximab in a patient diagnosed with Crohn's disease who had no past history of Tbc and showed a negative screening test.

크론병이 스테로이드에 불응성이거나 의존적인 경우, 누공병변을 동반한 경우에 $TNF-{\alpha}$ 억제제인 infliximab이 효과적이나 결핵을 일으키는 부작용이 있다. 저자들은 결핵의 병력이 없고 선별검사상 음성인 크론병 환자에서 infliximab사용 후 다발성 중증 결핵이 합병된 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Keywords

References

  1. Kim SH, Yang SK, Kim KJ, et al. Efficacy of infliximab in the treatment of Korean patients with Crohn's disease. Korean J Gastroenterol 2009;54:108-116. https://doi.org/10.4166/kjg.2009.54.2.108
  2. Keane J, Gershon S, Wise RP, et al. Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent. N Engl J Med 2001;345:1098-1104. https://doi.org/10.1056/NEJMoa011110
  3. Gardam MA, Keystone EC, Menzies R, et al. Anti-tumour necrosis factor agents and tuberculosis risk: mechanisms of action and clinical management. Lancet Infect Dis 2003; 3:148-155. https://doi.org/10.1016/S1473-3099(03)00545-0
  4. Baker D, Clark J, Keenan G, et al. Tuberculosis occurring in patients receiving the anti-TNF-$\alpha$ agent infliximab. Arthritis Rheum 2001;44(Suppl):S105.
  5. Kim YH, Lee BJ, Park JJ, et al. Tuberculous meningitis in a patient with Crohn's disease, which was treated with infliximab. Korean J Gastrointest Endosc 2007;34:339-342.
  6. Korea Food and Drug Administration. The therapeutic guide-line of latent tuberculosis in trial of anti-TNF agents. 2004:1-6.
  7. Mow WS, Abreu-Martin MT, Papadakis KA, Pitchon HE, Targan SR, Vasiliauskas EA. High incidence of anergy in inflammatory bowel disease patients limits the usefulness of PPD screening before infliximab therapy. Clin Gastroenterol Hepatol 2004;2:309-313. https://doi.org/10.1016/S1542-3565(04)00060-6
  8. Kwok SK, Park SH. Guidelines for prevention of tuberculosis in patients with rheumatoid arthritis treated with TNF-alpha blockers. J Korean Rheum Assoc 2007;14: 105-111. https://doi.org/10.4078/jkra.2007.14.2.105
  9. Garcia Vidal C, Rodríguez Fernandez S, Martinez Lacasa J, et al. Paradoxical response to antituberculous therapy in infliximab-treated patients with disseminated tuberculosis. Clin Infect Dis 2005;40:756-759. https://doi.org/10.1086/427941
  10. Sichletidis L, Settas L, Spyratos D, Chloros D, Patakas D. Tuberculosis in patients receiving anti-TNF agents despite chemoprophylaxis. Int J Tuberc Lung Dis 2006;10:1127-1132.