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Prolonged paradoxical response to anti-tuberculous treatment after infliximab
Sara Melboucy-Belkhir1, Gabriella Flexor, Jérôme Stirnemann
1Service de Médecine Interne, Hôpital Jean-Verdier, Assistance Publique-Hôpitaux de Paris, Université Paris 13, avenue du 14 Juillet, Bondy Cedex, France. melboucysara@yahoo.fr
Abstract:
A 56-year-old woman with ankylosing spondylitis, treated for 3 months with infliximab, developed miliary tuberculosis with mediastinal lymphadenopathies and brain and splenic lesions. After initial improvement under anti-tuberculous therapy, she suffered an unexpectedly prolonged paradoxical worsening with several episodes of lymphadenopathy, including life-threatening ones, over a period of more than 14 months of follow-up. The outcome was favorable as a result of corticosteroid and surgical treatments. This phenomenon reflects a paradoxical reaction precipitated by infliximab withdrawal.
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