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Tuberculosis: 2 case reports In a case report, a 64-year-old woman and a 27-year-old man were described, who developed tuberculosis (TB) while receiving certolizumab-pegol for rheumatoid arthritis (RA) or adalimumab for ankylosing spondylitis [routes and dosages not stated; not all outcomes stated]. A 64-year-old woman, who had RA, started receiving certolizumab-pegol [certolizumab] in 2014. After 4 years, at the age of 64 years, she presented with weight loss and cough. Chest X-ray showed 1.4cm round opacity in right upper lobe. Subsequently, she underwent surgical resection, and histology revealed acid fast bacilli on ZN stain, with superimposed aspergilloma. TB was diagnosed. She was treated with unspecified quadruple therapy, and certolizumab-pegol was switched to etanercept. A 27-year-old man had ankylosing spondylitis since 2015. In 2016, he was started on adalimumab injection. Two years later, at the age of 27 years, he presented with multiple tender subcutaneous nodules over lower abdomen and thighs. Skin biopsy showed superficial and deep perivascular inflammation with lymphocytes and a small number of eosinophils. Differentials included granulomatous infection or panniculitis due to injection site reaction. TB culture came back negative. However, repeat T Spot was positive. Thus, latent tuberculosis infection was suspected. Adalimumab was withdrawn, and he was treated for 3 months [specific drugs not stated]. Thereafter, adalimumab was restarted without any further complications. Sidhu AA, et al. Should we continue to test for latent tuberculosis infection in patients treated with biologics?. Rheumatology 59 (Suppl. 2): ii31 abstr. P32, Apr 2020. 803507478 Available from: URL: http://doi.org/10.1093/rheumatology/keaa111.031 [abstract]

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Reactions 17 Oct 2020 No. 1826