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Multidrug resistant miliary tuberculosis during infliximab therapy despite tuberculosis screening
Alexander Gin1, Con Dolianitis
1Department of Royal Melbourne Hospital, Melbourne, Victoria, Australia.
The Australasian Journal of Dermatology
|May 30, 2013
Summary
Multidrug-resistant miliary tuberculosis can develop during infliximab therapy for psoriasis, even with negative initial screening. Prompt treatment and careful monitoring allowed for safe infliximab reintroduction without recurrence.
Area of Science:
- Immunology
- Infectious Diseases
- Dermatology
Background:
- Infliximab is an effective biologic for psoriasis treatment.
- Tuberculosis (TB) is a risk associated with TNF-alpha inhibitors.
- Pretreatment screening for TB is standard practice.
Observation:
- A case of multidrug-resistant miliary tuberculosis occurred 9 months into infliximab therapy for psoriasis.
- Initial TB screening, including chest X-ray and interferon-gamma release assay, was negative.
- The patient received a 4-month course of amikacin, ethambutol, pyrazinamide, and moxifloxacin.
Findings:
- Successful treatment of multidrug-resistant miliary tuberculosis was achieved.
- Infliximab was safely restarted concurrently with anti-TB medications.
- No TB recurrence was observed 12 months after infliximab reintroduction.
Implications:
- This case highlights the potential for late-onset TB during infliximab treatment.
- It underscores the importance of vigilant TB monitoring in patients receiving TNF-alpha inhibitors.
- Safe reintroduction of infliximab is possible with appropriate anti-TB management.
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