Disseminated Tuberculosis and Lung Cancer Associated With Infliximab Treatment of Rheumatoid Arthritis

Abstract

In Brief Tumor necrosis factor (TNF)-α blockers have emerged as valuable tools in the treatment of active rheumatoid arthritis. The increased incidence of reactivated latent mycobacterial infection following institution of infliximab therapy has been reported. However, less is known about the risk of malignancy with use of anti-TNF antibodies. We present a case of disseminated tuberculosis, possible infection with Mycobacterium fortuitum, and lung cancer in association with infliximab therapy in a 55-year-old man with active rheumatoid arthritis who had received previously isoniazid chemoprophylaxis. We review the existing literature on anti-TNF agents and risk of tuberculosis and malignancy. Biological immunomodulators such as tumor necrosis factor-α (TNF-α) antagonist have revolutionized the treatment of active rheumatoid arthritis. Unfortunately, such therapy may lead to reactivation of fungal and mycobacterial diseases in susceptible hosts. Additionally, their contribution to the development of malignancies is uncertain. This paper describes a case of rheumatoid arthritis complicated by disseminated tuberculosis despite adequate isoniazid nuclear transcription factor κ B chemoprophylaxis and reviews the current understanding of role of anti-TNF-α therapy in reactivation tuberculosis and malignancy.