Abstract:

Objective

To investigate the diagnosis, treatment and prevention of reactivation of latent tuberculosis infection induced by adalimumab.

Methods

Clinical data of a 31 years old male patient with disseminated pulmonary tuberculosis caused by adalimumab during the treatment of psoriasis in the Second Affiliated Hospital of Xi’an Jiaotong University in March 2023 was analyzed, retrospectively. Relevant literatures were searched to explore the pathogenesis, clinical characteristics, diagnosis and treatment of the disease.

Results

The patient has been suffering psoriasis for 3 years and received treatment with adalimumab six months before the onset of the disease. Starting with fever and dry cough, the patient was diagnosed as disseminated pulmonary tuberculosis after admission based on a history of using biological agents, symptoms of fever and dry cough,pulmonary miliary changes, enlarged lymph nodes, and positive results in immunology and pathogen of tuberculosis infection. After the initiate anti-tuberculosis treatment with isoniazid (300 mg, once a day), rifampicin (600 mg, once a day), pyrazinamide (500 mg, 3 times a day) and ethambutol (1 000 mg, once a day), and combined intravenous injection moxifloxacin (400 mg, once a day), the patient’s body temperature dropped to normal and cough disappeared. Follow-up was performed for 5 months, the patient did not have a fever or cough; repeated chest CT showed diffuse multiple miliary nodules disappeared in both lungs.

Conclusions

During the process of TNF-α antagonist therapy including adalimumab, it is necessary to closely monitor the symptoms, signs, chest X-ray, and to strengthen the pre-medication evaluation and monitoring during medication, process, which can contribute to prevent or intervene early in tuberculosis infection or reactivation caused by adalimumab.

Key words: Adalimumab, Disseminated tuberculosis, Latent tuberculosis infection, Psoriasis