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- W2802254888 abstract "A 48-year-old Algerian man with azathioprine-treated ulcerative colitis developed lymphocytopenia (450 cells/mm3) prompting a switch to adalimumab. An interferon-gamma release assay (IGRA) was negative. One month later, he developed dysphagia and dysphonia, progressing to febrile laryngeal dyspnoea despite a 2-week course of amoxicillin–clavulanate and corticosteroids. Endoscopy revealed an extensive laryngeal infiltration with adherent deposits (Figure 1A). A computed tomography (CT) scan showed laryngeal circumferential oedema and a left ventricle abscess (Figure 1B), and left lower pulmonary lobe condensation with ground-glass infiltrates (Figure 1C). Levofloxacin–azithromycin combination therapy was initiated because of a positive Legionella pneumophila PCR on bronchoalveolar fluid. Laryngeal biopsy revealed neutrophilic and non-necrotic granulomatous infiltrates. Two weeks later, culture of bronchoalveolar fluid yielded multi-susceptible Mycobacterium tuberculosis. Standard anti-tuberculous multi-therapy was initiated. Of note, the lymphocytopenia had resolved (1240 cells/mm3) and the IGRA turned positive. The onset of a rash resulted in a treatment adjustment with isoniazid, pyrazinamide, and levofloxacin for a total of 9 months, and the patient’s clinical condition and CT scan results normalized. As most tuberculosis cases under anti-tumour necrosis factor alpha (TNF-α) therapy occur after 90 days of treatment (Wallis et al., 2005Wallis R.S. Broder M. Wong J. Lee A. Hog L. Reactivation of latent granulomatous infections by infliximab.Clin Infect Dis. 2005; 41: S194-S198Crossref PubMed Scopus (155) Google Scholar), this case is a reminder of the risk of rapid reactivation of latent tuberculosis, especially with monoclonal antibody preparations (Horsburgh and Rubin, 2011Horsburgh Jr., C.R. Rubin E.J. Clinical practice: latent tuberculosis infection in the United States.N Engl J Med. 2011; 397: 1441-1448Crossref Scopus (235) Google Scholar, Ledingham et al., 2005Ledingham J. Wilkinson C. Deighton C. British Thoracic Society (BTS) recommendations for assessing risk and managing tuberculosis in patients due to start anti–TNF-α treatments.Rheumatology (Oxford). 2005; 44: 1205-1206Crossref PubMed Scopus (69) Google Scholar). Given the severity of tuberculosis in this population and the potential for the IGRA to fail in lymphocytopenic patients (Keane et al., 2001Keane J. Gershon S. Wise R.P. Mirabile-Levens E. Kasznica J. Schwieterman W.D. et al.Tuberculosis associated with infliximab, a tumor necrosis factor alpha neutralizing agent.N Engl J Med. 2001; 345: 1098-1104Crossref PubMed Scopus (3269) Google Scholar, Sester et al., 2014Sester M. van Leth F. Bruchfeld J. Bumbacea D. Cirillo D.M. Dilektasli A.G. et al.Risk assessment of tuberculosis in immunocompromised patients. A TBNET study.Am J Respir Crit Care Med. 2014; 190: 1168-1176Crossref PubMed Scopus (171) Google Scholar), epidemiological risk-based therapy of latent tuberculosis could be proposed for patients originating from high burden areas (Keane et al., 2001Keane J. Gershon S. Wise R.P. Mirabile-Levens E. Kasznica J. Schwieterman W.D. et al.Tuberculosis associated with infliximab, a tumor necrosis factor alpha neutralizing agent.N Engl J Med. 2001; 345: 1098-1104Crossref PubMed Scopus (3269) Google Scholar). The authors acknowledge the members of the Lyon TB study group: Ader F, Biron F, Boibieux A, Bouaziz A, Braun E, Catho G, Chidiac C, Chumbi-Flores W, Conrad A, Couraud S, Devouassoux G, Dumitrescu O, Ferry T, Freymond N, Gerbier-Colomban S, Gillet Y, Goutelle S, Grard S, Grima R, Hees L, Hodille E, Kiakouama-Maleka L, Lina G, Maury JM, Miailhes P, Perpoint T, Perrot E, Provoost J, Reix P, Ronaux-Baron AS, Roux S, Sénéchal A, Souquet PJ, Tronc F, Valour F, Vanhems P. Funding: None. Conflict of interest: None, for all authors." @default.
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- W2802254888 date "2018-06-01" @default.
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- W2802254888 title "Severe laryngeal and pulmonary tuberculosis under anti-TNF-α therapy" @default.
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- W2802254888 doi "https://doi.org/10.1016/j.ijid.2018.04.797" @default.
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