Tuberc Respir Dis.  2012 Oct;73(4):234-238.

A Case of Peritoneal Tuberculosis Developed after Infliximab Therapy for Refractory RA

• Min JY
• Bang SY
• Min SY
• Lee DS
• Kim BS
• Kim JE
• Lee ES
• Pyo JY
• Sohn JW
• Kim TH
• Lee HS

Abstract

Recently, interferon gamma releasing assay has been recommended to compensate the tuberculin skin test (TST) for screening for latent tuberculosis infection (LTBI). Although it improved the detection of LTBI before treatment with tumor necrosis factor blocker, its application to immune suppressed patients is limited. We report a case of peritoneal tuberculosis (TB) developed in a patient who tested positive for TST and QuantiFERON-TB Gold (QFT-G) before infliximab therapy, to emphasize the importance of monitoring during treatment. A 52-year-old woman presented with abdominal distension. She had been diagnosed with seropositive rheumatoid arthritis six years ago. She had started taking infliximab six months ago. All screening tests for TB were performed and the results of all were negative. At admission, the results of repeated TST and QFT-G tests were positive. Histopathological examination confirmed peritoneal TB. The patient started anti-TB therapy and the symptoms were relieved.

Keyword

Peritonitis, Tuberculous; Infliximab

MeSH Terms

Antibodies, Monoclonal
Arthritis, Rheumatoid
Female
Humans
Interferons
Latent Tuberculosis
Mass Screening
Middle Aged
Peritonitis, Tuberculous
Skin Tests
Tuberculin
Tumor Necrosis Factor-alpha
Infliximab
Antibodies, Monoclonal
Interferons
Tuberculin
Tumor Necrosis Factor-alpha

Figure

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  Figure 1 Large amount of ascites, peritoneal irregular thickening and omental nodules suggesting peritoneal tuberculosis in the abdomen computed tomography.

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  Figure 2 (A) Multiple granulomas surrounded by Langhans giant cells, and few lymphocytes and caseous necrosis (H&E stain, ×100). (B) Caseous necrosis and few lymphocytes in granuloma (H&E stain, ×400). A acid-fast bacillus is seen (inset; Ziehl-Neelsen stain, ×1,000).

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