Adalimumab
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Adalimumab Disseminated tuberculosis and immune reconstitution inflammatory syndrome following drug withdrawal: case report
A 44-year-old woman developed disseminated tuberculosis during treatment with adalimumab for severe cutaneous psoriasis. Additionally, she developed immune reconstitution inflammatory syndrome (IRIS) following withdrawal of adalimumab [duration of treatment to reactions onsets not stated]. The woman with severe cutaneous psoriasis was receiving adalimumab 40mg every other week for 3 years [route not stated]. She presented to the dermatology clinic with general malaise, cough and fever. She was hospitalised for additional work-up. Chest, abdominal and pelvic CT showed mediastinal lymph node enlargement along with spleen granulomas and liver. Pathological examination of a mediastinal lymph node biopsy showed an epithelioid giant-cell granuloma with caseous necrosis. PCR assay showed the presence of Mycobacterium tuberculosis complex DNA. Further, pathological, endoscopic, biological, and radiographic test results confirmed the diagnosis of multisensitive mediastinal lymph node, spleen and liver tuberculosis (disseminated tuberculosis). The woman’s adalimumab therapy was stopped. She was scheduled to receive a combination antituberculosis therapy comprising rifampicin, isoniazid, ethambutol and pyrazinamide for two months, followed by isoniazid and rifampicin for seven months. However, five weeks later, her radiological and clinical symptoms worsened indicating IRIS in the setting of withdrawal of adalimumab. Then, she received unspecified corticosteroid treatment in addition to antituberculosis treatment. Later, she had a severe psoriasis flare and psoriatic arthritis. A year after stopping antituberculosis treatment, apremilast and acetretin were initiated, but both were stopped due to poor tolerance and efficacy. Sixteen months after stopping antituberculosis treatment, ustekinumab was initiated and she exhibited good efficacy and tolerance without any signs of tuberculosis reactivation and IRIS. Benchoukroun S, et al. Disseminated tuberculosis complicated by immune reconstitution inflammatory syndrome under anti-TNF treatment. European Journal of Dermatology 803500260 30: 322-323, No. 3, May-Jun 2020. Available from: URL: http://doi.org/10.1684/ejd.2020.3774
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Reactions 12 Sep 2020 No. 1821
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