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Tuberculous peritonitis during infliximab therapy

J C Verhave1, R van Altena, M J H Wijnands

  • 1Department of Internal Medicine and Rheumatology, TweeSteden Hospital, Tilburg, the Netherlands. j_c_verhave@yahoo.com

The Netherlands Journal of Medicine
|February 23, 2008
PubMed

Insights

Anti-TNF therapy, like infliximab, can cause tuberculosis reactivation. Tuberculous peritonitis is a difficult-to-diagnose extrapulmonary form requiring prompt treatment and screening before therapy.

Area of Science:

  • Immunology
  • Infectious Diseases
  • Rheumatology

Background:

  • Anti-tumor necrosis factor (anti-TNF) therapies, including infliximab, are effective for autoimmune diseases like rheumatoid arthritis.
  • However, these treatments carry a risk of opportunistic infections, notably tuberculosis (TB).
  • Extrapulmonary TB, particularly tuberculous peritonitis, presents diagnostic challenges during anti-TNF therapy.

Observation:

  • Two rheumatoid arthritis patients developed tuberculous peritonitis after infliximab treatment.
  • Clinical presentation of tuberculous peritonitis was nonspecific, complicating early diagnosis.
  • Mycobacterium tuberculosis was difficult to detect in ascites fluid samples.

Findings:

  • Infliximab therapy was associated with the development of tuberculous peritonitis in these cases.
  • Nonspecific symptoms and low bacterial load in ascites hinder rapid diagnosis of TB peritonitis.
  • Early initiation of tuberculostatic therapy is crucial upon clinical suspicion.

Implications:

  • Thorough screening for latent or active tuberculosis is essential before initiating anti-TNF therapy.
  • Increased vigilance for extrapulmonary TB is required in patients on anti-TNF agents.
  • Prompt diagnosis and treatment of TB peritonitis are critical to prevent severe outcomes.

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