Infliximab
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Infliximab Splenic tuberculosis: case report A 43-year-old man developed splenic tuberculosis after starting infliximab therapy for psoriasis. The man had a 9-year history of psoriasis without joint impairment. His psoriasis was unresponsive to topical therapies and he was unable to tolerate treatment with acitretin and methotrexate; therefore, use of infliximab was indicated. Pretreatment work-up included normal chest xray findings and a negative tuberculin skin test. Infliximab 50 mg/kg was administered as an infusion in weeks 0, 2 and 6. He also received oral methotrexate to inhibit the production of antibodies. His skin lesions showed a significant improvement; however, 1 month after his third infliximab infusion, he presented with daily fever in the evenings, asthenia and weight loss. A chest CT scan showed left pleural effusion, associated with passive atelectasis of the basal segments of lower lobe, in addition to subtle nodular opacities with a ground-glass appearance on the right upper lobe. A abdominal CT showed splenomegaly. A splenic puncture with cultures for bacteria, fungi and Koch’s bacilli was performed, and these were all negative. Polymerase chain reaction for Koch’s bacilli in blood and urine was also negative. Serology for paracoccidioidomycosis and histoplasmosis was not reactive. Histopathological testing of splenic fragment showed granulomatous splenitis of an undetermined type. Empirical therapy with rifampicin, isoniazid and pyrazinamide for tuberculosis was commenced, leading to total regression of the man’s symptoms and splenic lesions. At last follow-up, his psoriatic lesions had not recurred. Fortaleza GT, et al. [Splenic tuberculosis during psoriasis treatment with infliximab]. Anais Brasileiros de Dermatologia 84: 420-4, No. 4, Aug 2009 803008316 [Portuguese; summarised from a translation] - Brazil
0114-9954/10/1293-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Reactions 20 Mar 2010 No. 1293
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