Adalimumab

Abstract

Disseminated tuberculosis: case report A 27-year-old man developed disseminated tuberculosis (TB) during treatment with adalimumab for Crohn’s disease (CD). The man presented in the hospital with a 4-week history of Crohn ileitis which was well controlled by adalimumab [dosage and route not stated]. Before starting anti-TNF therapy with adalimumab, he was tested for latent Mycobacterium tuberculosis infection which was revealed a negative result. Only splenomegaly was evident in the abdomen CT. Splenomegaly with multiple hypointense nodules involving the spleen was revealed in an abdominal CT scan. In the chest CT scan, an apicoposterior lung consolidation was observed and a multilobular, well-defined, ring-enhanced lesion within the cerebellar hemispheres was observed in cranial MRI. In acid-fast staining and culture from the bronchoalveolar lavage fluid, TB was confirmed [time to reactions onset not stated]. Therefore, the man treated with an unspecified four-drug anti-TB regimen and adalimumab was discontinued. After 3 months of anti-TB therapy excision of the cerebellar lesion were noted. Central caseous necrosis surrounded by granulomatous inflammation was detected in pathological analysis. A positive mycobacterial culture was noted. Splenic granulomatous inflammation, with large inflammatory necrosis and caseous necrosis, was also observed in the histopathological report. Because of treatment failure with anti-TB, he had multiple splenic lesions with multiple abscesses hence he underwent laparoscopic splenectomy. At the time of the report, he was on vedolizumab for CD and remained asymptomatic for CD.