MILIARY TUBERCULOSIS AS A SEVERE ADVERSE REACTION TO THE USE OF ADALIMUMAB IN CROHN'S DISEASE: A CASE REPORT

Autor: Felipe Bertollo Ferreira, Vitor Lorencini Belloti, Bruna Barcellos Chaia, Marina Dadalto Scarpati, João Eugênio Loureiro Lopes, Helena Demuner Vallandro
Jazyk: portugalština
Rok vydání: 2021
Předmět:
Zdroj: Arquivos Médicos dos Hospitais e da Faculdade de Ciências Médicas da Santa Casa de São Paulo; v. 66 (2021): Jan/Dez; 1 of 5
Arquivos Médicos dos Hospitais e da Faculdade de Ciências Médicas da Santa Casa de São Paulo
Faculdade de Ciências Médicas da Santa Casa de São Paulo
instacron:FCMSCSP
ISSN: 1809-3019
0101-6067
Popis: Introdução: A doença de Crohn é uma doença inflamatória intestinal (DII) que inicia um processo inflamatório crônico idiopático intestinal, levando a um quadro clínico variávelcujo principal sintoma é a diarreia crônica. O diagnóstico é feito a partir da combinação de dados clínicos, laboratoriais e exames endoscópicos. Após confirmado o diagnóstico, otratamento pode envolver classes medicamentosas como imunobiológicos. Em relação ao uso de imunobiológicos, como o adalimumabe, deve-se ter cautela pelo seu efeitoimunossupressor, que pode, em indivíduos susceptíveis, ativar focos latentes de infecção, como os de tuberculose (TB). Objetivo: Relatar um caso de tuberculose miliar como reação adversa ao uso de adalimumabe e conscientizar a comunidade médica quanto aos riscos da administração de terapia imunobiológica. Relato de caso: Paciente do sexo masculino, 31 anos, com diagnóstico de Doença de Crohn em acompanhamento ambulatorial com terapia imunobiológica com adalimumab, é admitido na emergência com quadro agudo de sintomas respiratórios e sistêmicos. Durante a investigação hospitalar, apesar de pesquisa do bacilo álcool- -ácido resistente (BAAR) no escarro ter apresentado três amostras negativas, a tomografia computadorizada (TC) de tórax apresentava padrão sugestivo de tuberculose miliar, além de um lavado broncoalveolar com pesquisa positiva para Mycobacterium tuberculosis. Confirmado o diagnóstico de TB miliar, o tratamento foi iniciado com rifampicina, isoniazida, pirazinamida e etambutol. Conclusão: Levando em consideração a alta mortalidade e os impactos negativos da tuberculose miliar, é imprescindível que todos os pacientes com DII em uso de imunobiológicos sejam rastreados para infecção latente, através da radiografia de tórax e teste tuberculínico (PPD). Entretanto, mesmo com o rastreio regular e registro de vacinação prévia, a possibilidade de tuberculose miliar ainda não pode ser descartada em quadros clínicos inespecíficos neste perfil de pacientes.Palavras chave: Adalimumab, Tuberculose, Efeitos colaterais e reações adversas relacionados a medicamentosABSTRACTIntroduction: Crohn’s disease is an inflammatory bowel disease (IBD) that initiates a chronic idiopathic intestinal inflammatory process, leading to a variety of clinical symptoms with chronic diarrhea as the main one. Diagnosis is built from a combination of clinical, laboratory and endoscopic data. The treatment involves immunobiological drugs, such as adalimumab and due to its immunosuppressive effect, it must be administered with caution, because it isable to activate latent foci of infection, such as tuberculosis (TB), in susceptible individuals. Objective: To report a miliary tuberculosis case originated as an adverse reaction to the use of adalimumab and to make the medical community aware of the risks of administering immunobiological therapy. Case report: A 31-year-old male, diagnosed with Crohn’s Disease, undergoing immunobiological treatment with adalimumab, is admitted in the emergency department with acute respiratory and systemic symptoms. During hospitalization, despite the investigation of alcohol-acid resistant bacillus (BAAR) in sputum showing three different samples with negative results, the computerized tomography (CT) of the chest showed a pattern suggestive of miliary tuberculosis, in addition to a bronchoalveolar lavage with a positive test for Mycobacterium tuberculosis. After the diagnosis of miliary TB was confirmed, treatment with rifampicin, isoniazid, pyrazinamide and ethambutol was started. Conclusion: Considering the high mortality and negative impacts of miliary tuberculosis, it is essentialthat all patients with IBD on immunobiological treatment are screened for latent infection through chest radiograph and PPD. However, even with regular screening and registration of previous vaccinations, the possibility of miliary tuberculosis cannot be ruled out in this profile of patients with unspecific clinical conditions.Keywords: Adalimumab, Tuberculosis, Drug-related side effects and adverse reactions Introduction: Crohn's disease is an inflammatory bowel disease (IBD) that initiates a chronic idiopathic intestinal inflammatory process, leading to a variable clinical manifestations whose chronic diarrhea main symptom is. Diagnosis is built from a combination of clinical, laboratory and endoscopic data. When diagnosed, treatment may involve drug classes such as immunobiologicals. Regarding the use of immunobiologicals, such as adalimumab, one should be cautious due to its immunosuppressive effect, able to, in susceptible individuals, activate latent foci of infection, such as tuberculosis (TB). Objective: To report a case of miliary tuberculosis as an adverse reaction to the use of adalimumab and to make the medical community aware of the risks of administering immunobiological therapy. Case report: A 31-year-old male patient diagnosed with Crohn's Disease under outpatient follow-up with adalimumab as immunobiological therapy is admitted to the emergency department with acute respiratory and systemic symptoms. During the hospital investigation, despite the investigation of alcohol-acid resistant bacillus (BAAR) in sputum, the computerized tomography (CT) of the chest showed a pattern suggestive of miliary tuberculosis, in addition to a bronchoalveolar lavage with a positive test for Mycobacterium tuberculosis. Once the diagnosis of miliary TB was confirmed, treatment was started with rifampicin, isoniazid, pyrazinamide and ethambutol. Conclusion: Taking into account the high mortality and negative impacts of miliary tuberculosis, it is essential that all patients with IBD using immunobiologicals are screened for latent infection through chest radiography and PPD. However, even with regular screening and registration of previous vaccinations, the possibility of miliary tuberculosis cannot be ruled out in nonspecific clinical conditions in this patient profile.
Databáze: OpenAIRE
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