Intest Res.  2016 Apr;14(2):183-186. 10.5217/ir.2016.14.2.183.

Rectal tuberculosis after infliximab therapy despite negative screening for latent tuberculosis in a patient with ulcerative colitis

• Singh J
• Puri AS
• Sachdeva S
• Sakhuja P
• Arivarasan K

• KMID: 2425292
• DOI: http://doi.org/10.5217/ir.2016.14.2.183

Abstract

Tumor necrosis factor-α inhibitors are now considered as standard therapy for patients with severe inflammatory bowel disease who do not respond to corticosteroids, but they carry a definite risk of reactivation of tuberculosis. We present a case in which a patient with inflammatory bowel disease developed a de novo tuberculosis infection after the start of anti-tumor necrosis factor-α treatment despite showing negative results in tuberculosis screening. Although there are many case reports of pleural, lymph nodal and disseminated tuberculosis following infliximab therapy, we present the first case report of rectal tuberculosis following infliximab therapy.

Keyword

Inflammatory bowel diseases; Colitis, ulcerative; Tumor necrosis factor-alpha; Tuberculosis; Adverse event

MeSH Terms

Adrenal Cortex Hormones
Colitis, Ulcerative*
Humans
Infliximab
Inflammatory Bowel Diseases
Latent Tuberculosis*
Mass Screening*
Necrosis
Tuberculosis*
Tumor Necrosis Factor-alpha
Ulcer*
Adrenal Cortex Hormones
Tumor Necrosis Factor-alpha

Figure

• 

  Fig. 1 Colonoscopic finding. Colonoscopic image of the patient showing moderate disease according to the Mayo score (marked erythema, lack of vascular pattern, friability, erosions and superficial ulcers).

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  Fig. 2 Chest X-ray finding. Chest radiograph showing left-sided pleural effusion (arrow).

• 

  Fig. 3 Sigmoidoscopic finding. Tubercular rectal ulcer (arrow) in the background of almost normal colonic mucosa.

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  Fig. 4 Histopathological finding. Histopathology from the rectal ulcer shows well-defined granuloma with epithelioid cells (arrow) (H&E, ×10).

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  Fig. 5 Chest X-ray finding. Complete resolution of pleural effusion on chest radiography after antitubercular therapy.

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