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Disseminated Tuberculosis in a Patient Taking Anti-TNF Therapy for Crohn's Disease.

Wang MH, Liu X, Shen B - ACG Case Rep J (2015)

Bottom Line: A man in his sixth decade with Crohn's colitis and who had been taking infliximab for 18 months presented with fever and weight loss.Colonoscopy showed circumferential ulcerations from the cecum to the descending colon, and biopsies showed extensive granulomas with central necrosis, positive for acid-fast bacteria.Brain MRI revealed a thalamic ring-enhanced mass with edema, consistent with tuberculoma.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH.

ABSTRACT
A man in his sixth decade with Crohn's colitis and who had been taking infliximab for 18 months presented with fever and weight loss. Chest CT showed numerous nodules in both lungs, and sputum culture grew Mycobacterium tuberculosis. Colonoscopy showed circumferential ulcerations from the cecum to the descending colon, and biopsies showed extensive granulomas with central necrosis, positive for acid-fast bacteria. Brain MRI revealed a thalamic ring-enhanced mass with edema, consistent with tuberculoma. Clinicians should be aware of the appropriate screening and close monitoring of tuberculosis before and during anti-tumor necrosis factor (TNF) therapy.

No MeSH data available.


Related in: MedlinePlus

Mycobacterium tuberculosis can be seen cording in liquid culture (100x magnification).
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Figure 3: Mycobacterium tuberculosis can be seen cording in liquid culture (100x magnification).

Mentions: He had a 2-month history of intermittent fever, fatigue, and weight loss of 18 kg. On this presentation, chest radiograph and chest CT showed numerous, bilateral, scattered, small (<5 mm) nodules, with some clustered in a tree-in-bed distribution (Figures 1 and 2). Three consecutive sets of sputum showed acid-fast bacteria, and liquid culture grew Mycobacterium tuberculosis (MTB; Figure 3). Colonoscopy showed extensive circumferential ulcerations segmentally distributed from the cecum to the descending colon (Figure 4). Colon biopsies showed large epithelioid granulomas with central necrosis that were positive for acid-fast bacteria (Figure 5).


Disseminated Tuberculosis in a Patient Taking Anti-TNF Therapy for Crohn's Disease.

Wang MH, Liu X, Shen B - ACG Case Rep J (2015)

Mycobacterium tuberculosis can be seen cording in liquid culture (100x magnification).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4612758&req=5

Figure 3: Mycobacterium tuberculosis can be seen cording in liquid culture (100x magnification).
Mentions: He had a 2-month history of intermittent fever, fatigue, and weight loss of 18 kg. On this presentation, chest radiograph and chest CT showed numerous, bilateral, scattered, small (<5 mm) nodules, with some clustered in a tree-in-bed distribution (Figures 1 and 2). Three consecutive sets of sputum showed acid-fast bacteria, and liquid culture grew Mycobacterium tuberculosis (MTB; Figure 3). Colonoscopy showed extensive circumferential ulcerations segmentally distributed from the cecum to the descending colon (Figure 4). Colon biopsies showed large epithelioid granulomas with central necrosis that were positive for acid-fast bacteria (Figure 5).

Bottom Line: A man in his sixth decade with Crohn's colitis and who had been taking infliximab for 18 months presented with fever and weight loss.Colonoscopy showed circumferential ulcerations from the cecum to the descending colon, and biopsies showed extensive granulomas with central necrosis, positive for acid-fast bacteria.Brain MRI revealed a thalamic ring-enhanced mass with edema, consistent with tuberculoma.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH.

ABSTRACT
A man in his sixth decade with Crohn's colitis and who had been taking infliximab for 18 months presented with fever and weight loss. Chest CT showed numerous nodules in both lungs, and sputum culture grew Mycobacterium tuberculosis. Colonoscopy showed circumferential ulcerations from the cecum to the descending colon, and biopsies showed extensive granulomas with central necrosis, positive for acid-fast bacteria. Brain MRI revealed a thalamic ring-enhanced mass with edema, consistent with tuberculoma. Clinicians should be aware of the appropriate screening and close monitoring of tuberculosis before and during anti-tumor necrosis factor (TNF) therapy.

No MeSH data available.


Related in: MedlinePlus