Resuming anti-TNF therapy after development of miliary tuberculosis in Behcet's disease-related uveitis: a case report.

Chika Toriu, Kinya Tsubota, Yoshihiko Usui, Hiroshi Goto
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Abstract

Purpose: There is no consensus concerning restarting anti-tumour necrosis factor (TNF)-α therapy for uveitis after treatment for active tuberculosis (TB). We report a case of Behcet disease (BD) in which treatment with TNF inhibitor was successfully resumed after treatment for miliary TB.

Case report: A 48-year-old Japanese male was treated for uveitis of unknown aetiology in the left eye at a general ophthalmology clinic. He was referred to Department of Ophthalmology, Tokyo Medical University Hospital because of macula oedema (ME) not responding to prednisolone (PSL) 20 mg. BD was diagnosed based on fluorescein angiographic findings of diffuse retinal vasculitis characteristic of BD, recurrent oral aphthous ulcer, erythema nodosum-like rash in his legs, and HLA-A26 positivity. After a screening test, adalimumab (ADA) was started as steroid-sparing therapy. Eight months after starting ADA, the patient was diagnosed with miliary TB. ADA and PSL were discontinued immediately due to TB. Anti-TB treatment was completed after 6 months based on clinical improvement, although T-SPOT.TB was still positive. Infliximab with isoniazid was started due to relapse of ME, worsened vitreous haze, and worsened visual acuity in his left eye. Subsequently, his ocular symptoms subsided and there was no relapse of TB.

Conclusion: This case suggests that in patients with BD who have discontinued anti-TNF therapy due to miliary TB, restarting anti-TNF therapy may be a therapeutic option after TB has been treated appropriately with careful monitoring for relapse.

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白塞氏病相关葡萄膜炎并发军性结核后恢复抗肿瘤坏死因子治疗1例报告
目的:活动性结核(TB)治疗后是否重新开始抗肿瘤坏死因子(TNF)-α治疗葡萄膜炎尚无共识。我们报告一例白塞病(BD)的治疗与TNF抑制剂成功恢复治疗后,军队结核。病例报告:一名48岁的日本男性在普通眼科诊所治疗不明原因的左眼葡萄膜炎。由于强的松龙(PSL) 20mg无效,他被转介到东京医科大学医院眼科。根据BD特征的弥漫性视网膜血管炎、复发性口腔溃疡、腿部结节样红斑和HLA-A26阳性的荧光素血管造影结果诊断为BD。筛选试验后,阿达木单抗(ADA)开始作为类固醇保留治疗。在开始抗结核药物治疗8个月后,患者被诊断为军人结核。由于结核病,ADA和PSL立即停用。基于临床改善,抗结核治疗在6个月后完成,尽管T-SPOT。结核病仍然呈阳性。因ME复发,玻璃体浑浊加重,左眼视力下降,开始使用英夫利昔单抗联合异烟肼治疗。随后,他的眼部症状消退,没有结核复发。结论:本病例提示,对于因军旅性结核病而停止抗tnf治疗的BD患者,在对结核病进行适当治疗并仔细监测复发后,重新开始抗tnf治疗可能是一种治疗选择。
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来源期刊
CiteScore
3.80
自引率
3.40%
发文量
39
审稿时长
13 weeks
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