Abstract
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-γ 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.
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Acknowledgements
We are indebted to Dr S Howaldt, Hamburg, for sharing details of the patient's previous history.
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Stefan Ehlers has been a consultant for, has been on a speaker's bureau for, and has received grant/research support from Amgen. Christoph Lange has been on a speaker's bureau for Cellestis, and he has been a consultant for, and has been on a speaker's bureau for Oxford Immunotech. The other authors declared no competing interests.
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Lange, C., Hellmich, B., Ernst, M. et al. Rapid immunodiagnosis of tuberculosis in a woman receiving anti-TNF therapy. Nat Rev Rheumatol 3, 528–534 (2007). https://doi.org/10.1038/ncprheum0571
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DOI: https://doi.org/10.1038/ncprheum0571
