Life-threatening disseminated tuberculosis as a complication of TNF-α blockade in an adolescent
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Steffen Hess1, Toni Hospach, Robert Nossal
1Department of Pediatric Cardiology and Intensive Care Medicine, Klinikum Stuttgart Olgahospital, Bismarckstr, 8, 70176 Stuttgart, Germany. s.hess@klinikum-stuttgart.de
Abstract:
Life-threatening disseminated tuberculosis developed in a 17-year-old girl who was treated with the TNF-α blocker adalimumab for refractory SAPHO syndrome. The patient presented to the emergency department with dyspnea and somnolence and within 2 h developed the clinical picture of a septic shock. In addition to this unusual presentation, she showed a complicated course with increasing cerebral granuloma formation in spite of adequate antimycobacterial treatment. Immune reconstitution after discontinuation of TNF blockade may contribute to this "paradoxical reaction." Possible implications for screening, diagnosis, and treatment of tuberculosis in children and adolescents receiving anti-TNF treatment are discussed.
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