Tuberculous Peritonitis Mimicking Malignancy during Adalimumab Therapy in a Patient with Rheumatoid Arthritis

Refik Demirtunç,Kadir Kayataş,Uğur Özensoy,Fügen Vardar Aker

doi:10.4236/jtr.2015.33011

Abstract

We present a case of tuberculous peritonitis in a 46-year-old woman with rheumatoid arthritis treated with adalimumab, and we review the association between anti-tumour necrosis factor therapy and tuberculosis. This case illustrates that tuberculosis can develop with atypical clinic and uncertain laboratory findings and may mimic malignancies during adalimumab therapy.

Highlights

Anti-tumor necrosis factor drugs have been used for more than 10 years to treat inflammatory conditions such as rheumatoid arthritis (RA), psoriatic arthritis, juvenile arthritis, inflammatory bowel diseases, ankylosing spondylitis and psoriasis [1].Post marketing surveillance has showed that long-term use of anti-TNF agents may increase the risk of developing serious infections, cancers such as lymphoma and skin cancer, lupus-like autoimmune disease, liver disease, demyelinating disorders and hematologic abnormalities [2]
In vitro studies suggest that TNF-α plays an important role in the regulation of granuloma formation, which serves to restrict bacterial growth [5] [6], enhances macrophage activation [7], chemokine production by macrophages [8] and immune cell recruitment during M. tuberculosis infection [9]
When we reviewed the literature on PubMed, there are few cases with anti-TNF therapy-associated TB peritonitis and only 6 TB peritonitis cases have been reported after adalimumab treatment

Summary

Introduction

Anti-tumor necrosis factor (anti-TNF) drugs have been used for more than 10 years to treat inflammatory conditions such as rheumatoid arthritis (RA), psoriatic arthritis, juvenile arthritis, inflammatory bowel diseases, ankylosing spondylitis and psoriasis [1]. Tuberculosis (TB) is the most frequent opportunistic, infection during anti-TNF drug therapy [3]. Anti-TNF-α therapy has been shown to be associated with an approximately 14-fold greater incidence of TB reactivation compared to healthy controls [4]. (2015) Tuberculous Peritonitis Mimicking Malignancy during Adalimumab Therapy in a Patient with Rheumatoid Arthritis. This can explain the higher incidence of TB observed in patients receiving anti TNF-α treatment [4]. We present a case of tuberculous peritonitis in a patient with rheumatoid arthritis treated with adalimumab

Case Report

Findings

Discussion