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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

A 1.2-cm ring-enhanced mass with peripheral edema at right thalamus in the gadolinium-enhanced brain MRI.
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Figure 6: A 1.2-cm ring-enhanced mass with peripheral edema at right thalamus in the gadolinium-enhanced brain MRI.

Mentions: During hospitalization, the patient developed intractable nausea and vomiting. The gadolinium-enhanced MRI of brain revealed a right thalamic ring-enhanced 1.2-cm mass with edema, consistent with tuberculoma, and several smaller punctate lesions in left parietal-temporal lobe and both cerebellar hemispheres (Figure 6). Cerebral spinal fluid analysis revealed high protein and low glucose levels, but a negative MTB culture. Infliximab was discontinued. With the concern of potential isoniazid-resistant tuberculosis (TB), the patient received amikacin in combination with the standard anti-TB regimen for the first 4 weeks before the drug-susceptibility result came back negative for isoniazid resistance. An anti-TB regimen of isoniazid, rifampin, ethambutol, and pyrazinamide for the first 2 months was started, followed by isoniazid and rifampin for an additional 8 months. After antiemetics and the continuation of anti-TB therapy, the patient's symptoms gradually improved. Subsequent sputum cultures were negative for TB. Repeated MRI of the brain showed a decrease in the size of the tuberculoma. Unfortunately, the patient suddenly became ill and died 8 months after diagnosis, presumably from complications of disseminated TB.


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

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

A 1.2-cm ring-enhanced mass with peripheral edema at right thalamus in the gadolinium-enhanced brain MRI.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: A 1.2-cm ring-enhanced mass with peripheral edema at right thalamus in the gadolinium-enhanced brain MRI.
Mentions: During hospitalization, the patient developed intractable nausea and vomiting. The gadolinium-enhanced MRI of brain revealed a right thalamic ring-enhanced 1.2-cm mass with edema, consistent with tuberculoma, and several smaller punctate lesions in left parietal-temporal lobe and both cerebellar hemispheres (Figure 6). Cerebral spinal fluid analysis revealed high protein and low glucose levels, but a negative MTB culture. Infliximab was discontinued. With the concern of potential isoniazid-resistant tuberculosis (TB), the patient received amikacin in combination with the standard anti-TB regimen for the first 4 weeks before the drug-susceptibility result came back negative for isoniazid resistance. An anti-TB regimen of isoniazid, rifampin, ethambutol, and pyrazinamide for the first 2 months was started, followed by isoniazid and rifampin for an additional 8 months. After antiemetics and the continuation of anti-TB therapy, the patient's symptoms gradually improved. Subsequent sputum cultures were negative for TB. Repeated MRI of the brain showed a decrease in the size of the tuberculoma. Unfortunately, the patient suddenly became ill and died 8 months after diagnosis, presumably from complications of disseminated TB.

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