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Biological therapy: a Risk Factor for Developing Tuberculosis – a Case Report

Yanitsa Dimitrova, Kristina Dimitrova, Hristina Pamukchiyska, Elena Harizanova, Diana Petkova

Abstract

Introduction: Crohn’s disease is an autoimmune chronic inflammatory disease that most commonly affects the terminal ileum and the proximal colon. It causes local tissue damage that considerably affects the mucosa and leads to the development of fissures and ulcerations. The contemporary strategy of treatment includes corticosteroids and immunosuppressants, as well as biological therapy with infliximab and adalimumab.

Materials and Methods: We present you the case of B.T. - a 21-year-old male diagnosed with Crohn’s disease 3 years ago. He had been subjected to biological treatment for 26 months with adalimumab prior to admittance to St. Marina University Hospital, Varna with clinical manifestation of acute respiratory infection. Physical examination and an imaging test (X-ray) showed no evidence of lobar infiltrate on the left. The persistent manifestation of the disease with fever, no evident recovery despite adequate antibacterial therapy, a history of positive past T-SPOT TB test and undergoing treatment with immunosuppressants required the implementation of additional tests: chest CT, FBS, Mantoux test, microbiology and laboratory testing, in order to determine the diagnosis.

Results: Direct bacterioscopy of bronchoalveolar lavage was positive for acid-fast bacteria. Based on the presented data and the clinical course of the disease, the final diagnosis was infiltrative pneumonic form of pulmonary tuberculosis. Tuberculostatic treatment was started in standard doses. Microbiological cultures were positive twice, the second time during tuberculostatic therapy, which required a longer period of treatment.

Conclusion: Biological therapy is a risk factor for developing tuberculosis. That requires accurate judgment and exclusion of underlying latent tuberculosis infection before starting the treatment. Monitoring and control tests are highly important for early diagnosis and successful treatment should a specific infection develop.


Keywords

tuberculosis, Crohn’s disease, biological therapy


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