A Case of Immune Reconstitution Syndrome Secondary to Discontinuation of Anti-TNF Agents in a Patient With Pulmonary Tuberculosis

Abounasr, Khader K.; Rogers, Linda

doi:10.1378/chest.136.4_meetingabstracts.51s-d

Cited by 2 publications

(1 citation statement)

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“…Cases of paradoxical aggravation of TB have been reported in patients withdrawn from anti-TNF treatment. This response has been attributed to the immune reconstitution following withdrawal of iatrogenic immunosuppression, defined as the Immune Reconstitution Inflammatory Syndrome (IRIS), and may require treatment with corticosteroids and NSAIDs [56,57].…”

Section: Chemoprophylaxismentioning

confidence: 99%

Risk of tuberculosis with the use of anti-TNF medications in psoriasis: incidence, screening and management

Kasiraman¹,

Atwan²,

Durojaiye³

et al. 2014

Dermatology Online Journal

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Tumor necrosis factor (TNF) plays an important role in containing mycobacterial infections. With the rapidly increasing role of TNF inhibitors in dermatology, tuberculosis (TB) is becoming an important and worrisome concern to dermatologists. This paper aims to provide a comprehensive review on the incidence of TB in patients treated with anti-TNF, the variety of TB screening methods, and management of these cases. Various national recommendations have been highlighted. The monoclonal antibodies, infliximab and adalimumab, appear to be more associated with the risk of TB reactivation than the soluble receptor etanercept. Tuberculosis associated with TNF inhibitors, in contrast to classical TB, is more likely to be disseminated, atypical, extra pulmonary, and life threatening. Vigilance for typical and atypical presentations of active TB is mandatory until the end of therapy. Although tuberculin standard test (TST) has been the gold standard for screening of latent TB infection (LTBI) for close to a century, it has several inadequacies and may be unreliable in patients with widespread psoriasis. Interferon gamma release assays (IGRAs) with better diagnostic specificity and sensitivity are a promising adjunct to diagnose LTBI at present. Although appropriate screening and treatment of LTBI will lower the risk of reactivation to a great extent, no chemoprophylactic regimen is fully protective.

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Section: Chemoprophylaxismentioning

confidence: 99%