Development of Disseminated Tuberculosis with Intestinal Involvement due to Adalimumab Administration Despite Latent Tuberculosis Treatment

• Published in: Internal Medicine Vol. 59; no. 6; pp. 849 - 853
• Main Authors: Ikuta, Kozo, Ota, Yumiko, Kuroki, Shigenobu, Matsumoto, Yoshihide, Senda, Eri, Mukohara, Saki, Takahashi, Soshi, Monden, Kazuya, Fukuda, Akihisa, Seno, Hiroshi, Kumagai, Shunichi, Shio, Seiji
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 15-03-2020; Japan Science and Technology Agency
• Subjects: anti-TNFα inhibitor; Case Report; disseminated tuberculosis; Internal medicine; intestinal tuberculosis; Intestine; latent tuberculosis infection; Monoclonal antibodies; Mucosa; reactivation of tuberculosis; Rheumatoid arthritis; Sputum; Tuberculosis; Tumor necrosis factor-TNF; Tumor necrosis factor-α; disseminated tuberculosis; latent tuberculosis infection; reactivation of tuberculosis; intestinal tuberculosis; anti-TNFα inhibitor
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.3295-19

Treatment of latent tuberculosis infection (LTBI) reduces the probability of reactivation of tuberculosis associated with anti-tumor necrosis factor (TNF) α inhibitors, but no chemoprophylaxis is completely protective. We herein report a woman with rheumatoid arthritis who developed disseminated tuberculosis with intestinal involvement during adalimumab administration despite LTBI treatment. Tuberculosis reactivation was not detected in sputum or urine but was detected from the terminal ileal mucosa. Detection of intestinal tuberculosis is rare in patients being treated with anti-TNFα therapy after LTBI treatment. As anti-TNFα inhibitors have become more common, the rate of reactivation of tuberculosis, including intestinal tuberculosis, has increased in patients being treated for LTBI.