Source: International Congress 2015 – Case series and clinical conundrums in TB
Disease area: Respiratory infections

Abstract

Aims:TNF-alpha inhibitors widely used for the treatment of chronic inflammatory diseases in recent years. The increased risk of tuberculosis (TB) is the most important side effects of TNF-alpha inhibitors useage. We want to share the features of 19 patients who developed TB during the treatment of TNF-alpha inhibitors.Findings:The data files of patients who admitted to approval for the TNF-alpfa inhibitors treatment, were retrospectively evaluated between 2002-2014. 19 patients developped TB. 9(%47) patients were female, 10(%53) were male. The average age of patients were 38,4±13,9. 12(%63.2) patients were still smoking (40±11,8 packet-year), 7(%36,8) patients who never smoked. The primary disease for using TNF alpha inhibitors treatment were; 10 patients with ankylosing spondylitis, 4 Rheumatoid Arthritis, 3 patients with Behçet's disease, 1 Takayasu Arteritis, 1 Psoriatic Arthritis. 9 patients used Infliximab, 6 Adalimumab, 4 Enbrel treatment. The PPD values of the patient;7 patients were 0mm, 11 were ppd ³5mm, we didnt apply ppd test to 1 patient because of previous history of anti-tuberculosis treatment. 11 (%57,7) patients received INH prophylaxis, 8 (%42.1) patients didn't. Culture positive pulmonaryTB occurred in 7 patients (%36,8), 12 (63.2%) patients developped extrapulmonary TB (4 miliary TB, 3 tuberculous pleurisy, 2 patients with gastrointestinal TB, 1 tuberculosis lymphadenitis, 1 urogenital TB, 1 ear TB). All patients have completed the tuberculosis treatment.Conclusion: The TB risk is increased in patients who use TNF alpha inhibitor therapy, and majority of them are extrapulmonary tuberculosis. The clinicians must be careful in terms of extrapulmonary tuberculosis in these patients.


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Sermin Börekçi (Istanbul, Turkey), Sermin Borekci, Deniz Demir Yilmaz, Ersan Atahan, Yesim Ozguler, Benan Musellim, Vedat Hamuryudan, Hurrem Gul Ongen. Tuberculosis in patients receiving treatment of TNF-alpha inhibitors. Eur Respir J 2015; 46: Suppl. 59, 2754

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