Pulmonary Mycobacterium szulgai Infection and Treatment in a Patient Receiving Anti-Tumor Necrosis Factor Therapy

Jakko van Ingen; Martin Boeree; Matthijs Janssen; Erik Ullmann; Wiel de Lange; Petra de Haas; Richard Dekhuijzen and Dick van Soolingen


Nat Clin Pract Rheumatol. 2007;3(7):414-419. 

In This Article


The important role that TNF has in granuloma formation and maintenance, which is essential in host defense against mycobacteria, has been demonstrated by the many cases of tuberculosis reactivation described.[7,8,9] Few cases of nontuberculous mycobacterial infections in patients receiving anti-TNF therapy have been reported.[9,10,11] Given the low incidence and lack of good diagnostic instruments, specific screening for nontuberculous mycobacterial infections is currently not feasible; however, candidates for anti-TNF treatment with known lung disease, specifically COPD and bronchiectasis, should have their sputum repeatedly cultured for mycobacteria. Furthermore, clinicians involved in anti-TNF treatment should be aware of the potential emergence of nontuberculous mycobacterial infections in their patients. If a nontuberculous mycobacterial infection occurs, strictly supervised continuation of anti-TNF agents during antimycobacterial treatment might be safe and effective.

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