Macit GÜLTEN, Enver DOLAR, Selim Giray NAK, Hüseyin USLUSOY, Murat KIYICI, Murat KESKİN, Güze ÖZAL, Selim GÜREL

Fistülizan tip Crohn hastalığında infliksimab kullanımı sonrasında yaygın tüberküloz enfeksiyonu gelişen bir olgu - Reaktivasyon mu? IRIS mı?

Fistülizan tip Crohn hastalığı nedeni ile tek doz infliksimab kullanılan bir hastada gelişen yaygın tüberküloz enfeksiyonu ve ciddi enfeksiyonlar sonrası fatal seyir izlenmişti. Tümör Nekrozis Faktör-a antagonistlerinin romatoid artrit, Crohn hastalığı ve psöriaziste kullanım endikasyonları vardır. Ancak bu ajanların kullanımına bağlı başta tüberküloz olmak üzere birçok önemli komplikasyon görülebilmektedir. Sunduğumuz olgunun ışığında oldukça güncel olan bu konudaki literatür tekrar değerlendirilmiş ve konsensüs sağlanan görüşler sunulmuştur.

A case of disseminated tuberculosis after infliximab administration for fistulating Crohn disease - Is it reactivation or IRIS?

A single dose of infliximab administration for a patient with fistulating Crohn's disease led to a fatal course after disseminated tuberculosis and fungal sepsis. Tumor Necrosis Factor-a antagonists are known to have administrative indication in romatoid arthritis, Crohn's disease and psoriasis. However, many important complications may be seen during their usage, especially tuberculosis. In this report, the case was discussed, the literature was reviewed and main points with consensus were presented.

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Stenson WF, Korzenik J. Inflammatory Bowel Disease. In: Yamada T, Alpers DH, Kaplowitz N, Laine L, Owyang C, Powell DW (eds). Textbook of Gastroenterology. 4th edition. Philadelphia: Lippincott Williams & Wilkins; 2003. 1699- 1759.
Nash PT, Florin TH. Tumour necrosis factor inhibitors. Med J Aust 2005; 183:205-8.
Targan SR, Hanauer SB, van Deventer SJ, Mayer L, Present DH, Braakman T, DeWoody KL, Schaible .TF, Rutgeerts PJ. A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor alpha for Crohn's disease. Crohn's Dis ease cA2 Study Group. N Engl J Med 1997;337:1029-35.
Wallis RS, Ainir-Tahmasseb M, Ellner JJ. Induction of inter leukin 1 and tumor necrosis factor by mycobacterial proteins: the monocyte western blot. Proc Natl Acad Sci USA 1990;87:3348-52.
Kindler V, Sappino AP, Grau GE, Piguet PF, Vassalli P. The inducing role of tumor necrosis factor in the development of bactericidal granulomas during BCG infection. Cell 1989;56:731-40.
Wallis RS. Reconsidering adjuvant immunotherapy for tuber culosis. Clin Infect Dis 2005;41:201-8.
Hanauer SB, Wagner CL, Bala M, Mayer L, Travers S, Dia mond RH, Olson A, Bao W, Rutgeerts P. Incidence and im portance of antibody responses to infliximab after mainte nance or episodic treatment in Crohn's disease. Clin Gastroen terol Hepatol 2004;2:542-53.
Present DH, Rutgeerts P, Targan S, Hanauer SB, Mayer L, van Hogezand RA, Podolsky DK, Sands BE, Braakman T, DeWoody KL, Schaible TF, van Deventer SJ. Infliximab for the treatment of fistulas in patients with Crohn's disease. N Engl J Med 1999,340:1398-405.
Rutgeerts P, Feagan BG, Lichtenstein GR, Mayer LF, Schrei ber S, Colombel JF, Rachmilewitz D, Wolf DC, Olson A, Bao W, Hanauer SB. Comparison of scheduled and episodic treat ment strategies of infliximab in Crohn's disease. Gastroen terology 2004; 126:402-13.
Wolfe F, Michaud K, Anderson J, Urbansky K. Tuberculosis infection in patients with rheumatoid arthritis and the effect of infliximab therapy. Arthritis Rheum 2004;50:372-9.
Keane J, Gershon S, Wise RP, Mirabile-Levens E, Kasznica J, Schwieterman WD, Siegel JN, Braun MM. Tuberculosis asso ciated with infliximab, a tumor necrosis factor alpha- neutralizing agent. N Engl J Med 2001 ;345:1098-104.
Molenaar ET, Bultink IE, Dijkmans BA, Lems WF. Devel opment of fatal tuberculosis in a patient with rheumatoid ar thritis after three years of treatment with infliximab: comment on the article by Wolfe et al. Arthritis Rheum 2005;52:1334-6.
Uthman I, Sharara A. The usefulness of PPD testing in in flammatory bowel disease patients before infliximab therapy. Clin Gastroenterol Hepatol 2004;2:xxii.
Ormerod LP. Assessing risk and managing Myeobacterium tuberculosis infection and disease in patients due to start anti TNFalpha treatment. Cytokine 2004;28:179-81.
Carmona L, Gomez-Reino JJ, Rodriguez-Valverde V, Mon tero D, Pascual-Gomez E, Mola EM, Carreno L, Figueroa M; BIOBADASER Group. Effectiveness of recommendations to prevent reactivation of latent tuberculosis infection in patients treated with tumor necrosis factor antagonists. Arthritis Rheum 2005 ;52:1766-72.
Mow WS, Abreu-Martin MT, Papadakis KA, Pitchon HE, Targan SR, Vasiliauskas EA. High incidence of anergy in in flammatory bowel disease patients limits the usefulness of PPD screening before infliximab therapy. Clin Gastroenterol Hepatol 2004;2:309-13.
Karakousis PC, Yoshimatsu T, Lamichhane G, Woolwine SC, Nuermberger EL, Grosset J, Bishai WR. Dormancy phenotype displayed by extracellular Myeobacterium tuberculosis within artificial granulomas in mice. J Exp Med 2004;200:647-57.
Wallis. RS, Kyambadde P, Johnson JL, Horter L, Kittle R, Pohle M, Ducar C, Millard M, Mayanja-Kizza H, Whalen C, Okwera A. A study of the safety, immunology, virology, and microbiology of adjunctive etanercept in HIV-1-associated tu berculosis, AIDS 2004; 18:257-64.
Garcia Vidal C, Rodriguez Fernandez S, Martinez Lacasa J, Salavert M, Vidal R, Rodriguez Garballeira M, Garau J. Para doxical response to antituberculous therapy in infliximab treated patients with disseminated tuberculosis. Clin Infect Dis 2005;40:756-9.