Abstract
Life-threatening disseminated tuberculosis developed in a 17-year-old girl who was treated with the TNF-α blocker adalimumab for refractory SAPHO syndrome. The patient presented to the emergency department with dyspnea and somnolence and within 2 h developed the clinical picture of a septic shock. In addition to this unusual presentation, she showed a complicated course with increasing cerebral granuloma formation in spite of adequate antimycobacterial treatment. Immune reconstitution after discontinuation of TNF blockade may contribute to this "paradoxical reaction." Possible implications for screening, diagnosis, and treatment of tuberculosis in children and adolescents receiving anti-TNF treatment are discussed.
MeSH terms
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Acquired Hyperostosis Syndrome / drug therapy*
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Acquired Hyperostosis Syndrome / immunology
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Adalimumab
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Adolescent
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Anti-Inflammatory Agents / adverse effects
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Antibodies, Monoclonal, Humanized / adverse effects*
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Antitubercular Agents / therapeutic use
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Aza Compounds / therapeutic use
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Drug Therapy, Combination
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Dyspnea / microbiology
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Ethambutol / therapeutic use
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Female
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Fluoroquinolones
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Humans
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Immunocompromised Host*
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Immunosuppressive Agents / adverse effects*
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Moxifloxacin
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Quinolines / therapeutic use
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Severity of Illness Index
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Shock, Septic / microbiology
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Treatment Outcome
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Tuberculosis, Miliary / complications
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Tuberculosis, Miliary / diagnosis*
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Tuberculosis, Miliary / drug therapy
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Tuberculosis, Miliary / immunology*
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Tumor Necrosis Factor-alpha / antagonists & inhibitors*
Substances
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Anti-Inflammatory Agents
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Antibodies, Monoclonal, Humanized
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Antitubercular Agents
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Aza Compounds
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Fluoroquinolones
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Immunosuppressive Agents
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Quinolines
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Tumor Necrosis Factor-alpha
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Ethambutol
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Adalimumab
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Moxifloxacin