Rapid Immunodiagnosis of Tuberculosis in a Woman Receiving Anti-TNF Therapy

Christoph Lange; Bernhard Hellmich; Martin Ernst; Stefan Ehlers

Disclosures

Nat Clin Pract Rheumatol. 2007;3(9):528-534. 

In This Article

Summary

Background: A 63-year-old German woman with a 24-year history of Crohn's disease and associated polyarthralgias presented with severe malaise, dyspnea, fever, night sweats, dry cough and an extensive right-sided pleural effusion. The patient had begun treatment with bi-weekly subcutaneous injections of adalimumab 5 weeks earlier.
Investigations: Physical examination, chest X-ray, transthoracic ultrasonography, pleural tap and drainage, bacterial and cytological analyses of pleural fluid, bronchoscopy, microscopy and bacteriological culture of pleural exudates and bronchoalveolar lavage fluid, thoracic CT, thoracoscopy, histopathology of pleural biopsy, tuberculin skin test, nucleic acid amplification of mycobacterial RNA and DNA in the pleural fluid specimens and the parietal pleural biopsy, microscopy of sputum samples, ESAT-6-specific and CFP-10-specific nterferon-enzyme-linked immunospot assay on peripheral blood and pleural exudate mononuclear cells.
Diagnosis: Pulmonary and pleural tuberculosis.
Management: Cessation of adalimumab treatment. Initiation of quadruple antibiotic therapy with isoniazid, rifampin, ethambutol and pyrazinamide. Prednisolone administered to reduce the pleural effusion.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.

processing....