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Clinical features of active tuberculosis that developed during anti-tumor necrosis factor therapy in patients with inflammatory bowel disease.

Lee JW, Choi CH, Park JH, Kim JW, Kang SB, Koo JS, Kim YH, Kim YS, Joo YE, Chang SK - Intest Res (2016)

Bottom Line: Positive findings in a TB skin test (TST) and/or interferon gamma releasing assay (IGRA) were observed in three patients, and two of them received anti-TB prophylaxis.Two patients were negative by both TST and IGRA.The most common site of active TB was the lungs, and the active TB was cured in all patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.

ABSTRACT

Background/aims: Anti-tumor necrosis factor (TNF) therapy for active ulcerative colitis (UC) and Crohn's disease (CD) is associated with increased risks of tuberculosis (TB) infection. We analyzed the incidence and clinical features of Korean patients with inflammatory bowel disease (IBD) who developed active TB during anti-TNF therapy.

Methods: Ten cases of active TB developed in patients treated with infliximab (n=592) or adalimumab (n=229) for UC (n=160) or CD (n=661) were reviewed. We analyzed demographics, interval between start of anti-TNF therapy and active TB development, tests for latent TB infection (LTBI), concomitant medications, and the details of diagnosis and treatments for TB.

Results: The incidence of active TB was 1.2% (10/821): 1.5% (9/592) and 0.4% (1/229) in patients receiving infliximab and adalimumab, respectively. The median time to the development of active TB after initiation of anti-TNF therapy was three months (range: 2-36). Three patients had past histories of treatment for TB. Positive findings in a TB skin test (TST) and/or interferon gamma releasing assay (IGRA) were observed in three patients, and two of them received anti-TB prophylaxis. Two patients were negative by both TST and IGRA. The most common site of active TB was the lungs, and the active TB was cured in all patients.

Conclusions: Active TB can develop during anti-TNF therapy in IBD patients without LTBI, and even in those with histories of TB treatment or LTBI prophylaxis. Physicians should be aware of the potential for TB development during anti-TNF therapy, especially in countries with a high prevalence of TB.

No MeSH data available.


Related in: MedlinePlus

Chest X-ray findings. A representative chest X-ray for the active tuberculosis developed in patients with CD during anti-tumor necrosis factor therapy. A patchy heterogeneous consolidation is visible in the left upper lobe of the lung.
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Figure 1: Chest X-ray findings. A representative chest X-ray for the active tuberculosis developed in patients with CD during anti-tumor necrosis factor therapy. A patchy heterogeneous consolidation is visible in the left upper lobe of the lung.

Mentions: Active TB was diagnosed by AFB staining for mycobacteria from tissue or sputum samples (n=7), AFB culture (n=3), TB PCR assay (n=2), or clinically with chest X-rays and CT scans of the thorax and abdomen (n=3). All cases of active TB involved the lungs. Two patients had also extra-pulmonary TB on the mediastinal lymph nodes and peritoneum, respectively. Cough was the most common symptom, followed by fever and sputum (Table 4). Fig. 1 shows a representative chest X-ray for the active TB developed in patient with CD.


Clinical features of active tuberculosis that developed during anti-tumor necrosis factor therapy in patients with inflammatory bowel disease.

Lee JW, Choi CH, Park JH, Kim JW, Kang SB, Koo JS, Kim YH, Kim YS, Joo YE, Chang SK - Intest Res (2016)

Chest X-ray findings. A representative chest X-ray for the active tuberculosis developed in patients with CD during anti-tumor necrosis factor therapy. A patchy heterogeneous consolidation is visible in the left upper lobe of the lung.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4863048&req=5

Figure 1: Chest X-ray findings. A representative chest X-ray for the active tuberculosis developed in patients with CD during anti-tumor necrosis factor therapy. A patchy heterogeneous consolidation is visible in the left upper lobe of the lung.
Mentions: Active TB was diagnosed by AFB staining for mycobacteria from tissue or sputum samples (n=7), AFB culture (n=3), TB PCR assay (n=2), or clinically with chest X-rays and CT scans of the thorax and abdomen (n=3). All cases of active TB involved the lungs. Two patients had also extra-pulmonary TB on the mediastinal lymph nodes and peritoneum, respectively. Cough was the most common symptom, followed by fever and sputum (Table 4). Fig. 1 shows a representative chest X-ray for the active TB developed in patient with CD.

Bottom Line: Positive findings in a TB skin test (TST) and/or interferon gamma releasing assay (IGRA) were observed in three patients, and two of them received anti-TB prophylaxis.Two patients were negative by both TST and IGRA.The most common site of active TB was the lungs, and the active TB was cured in all patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.

ABSTRACT

Background/aims: Anti-tumor necrosis factor (TNF) therapy for active ulcerative colitis (UC) and Crohn's disease (CD) is associated with increased risks of tuberculosis (TB) infection. We analyzed the incidence and clinical features of Korean patients with inflammatory bowel disease (IBD) who developed active TB during anti-TNF therapy.

Methods: Ten cases of active TB developed in patients treated with infliximab (n=592) or adalimumab (n=229) for UC (n=160) or CD (n=661) were reviewed. We analyzed demographics, interval between start of anti-TNF therapy and active TB development, tests for latent TB infection (LTBI), concomitant medications, and the details of diagnosis and treatments for TB.

Results: The incidence of active TB was 1.2% (10/821): 1.5% (9/592) and 0.4% (1/229) in patients receiving infliximab and adalimumab, respectively. The median time to the development of active TB after initiation of anti-TNF therapy was three months (range: 2-36). Three patients had past histories of treatment for TB. Positive findings in a TB skin test (TST) and/or interferon gamma releasing assay (IGRA) were observed in three patients, and two of them received anti-TB prophylaxis. Two patients were negative by both TST and IGRA. The most common site of active TB was the lungs, and the active TB was cured in all patients.

Conclusions: Active TB can develop during anti-TNF therapy in IBD patients without LTBI, and even in those with histories of TB treatment or LTBI prophylaxis. Physicians should be aware of the potential for TB development during anti-TNF therapy, especially in countries with a high prevalence of TB.

No MeSH data available.


Related in: MedlinePlus