Disseminated tuberculosis in a patient with severe psoriasis treated with adalimumab

Authors

  • Pamela Figueroa Austral University Hospital, Buenos Aires, Argentina
  • Lena Eimer Austral University Hospital, Buenos Aires, Argentina
  • Lucila Suar Austral University Hospital, Buenos Aires, Argentina
  • Corina Busso Austral University Hospital, Buenos Aires, Argentina
  • Rocío Gago Austral University Hospital, Buenos Aires, Argentina

Keywords:

psoriasis, disseminated tuberculosis, adalimumab, secukinumab

Abstract

WHO considers tuberculosis (TB) as one of the main causes of death worldwide, the first one among infectious diseases. Adalimumab is a monoclonal antibody that blocks the effect of tumor necrosis factor alpha (TNF-a) and is used widely for the treatment of severe psoriasis. A latent TBC may become active as a result of such therapy. We present a case of a 30-year-old man with severe plaque psoriasis treated with adalimumab who evolved with disseminated TB after four. The biologic therapy was withdrawn and he completed the TB treatment. Then, he started therapy with secukinumab (IL-17A) with excellent response.

Author Biographies

Pamela Figueroa, Austral University Hospital, Buenos Aires, Argentina

Médica Residente del Servicio de Dermatología

Lena Eimer, Austral University Hospital, Buenos Aires, Argentina

Staff Physician of the Dermatology Service and the Psoriasis Unit

Lucila Suar, Austral University Hospital, Buenos Aires, Argentina

Staff Physician of the Dermatology Service and the Psoriasis Unit

Corina Busso, Austral University Hospital, Buenos Aires, Argentina

Head of the Dermatology Service

Rocío Gago, Austral University Hospital, Buenos Aires, Argentina

Médica de Planta del Servicio de Infectología

References

I. Latorre P, Sánchez E, Agudelo Calderón C, Pardo R, et ál. Guía de atención de la tuberculosis pulmonar y extrapulmonar. Medicina & Laboratorio 2011;17:145-195.

II. Aidar O, Ambroggi M, Arévalo Jave J, Brian MC, ét al. Guías de diagnóstico, tratamiento y prevención de la tuberculosis. Hospital Muñiz/Instituto Vaccarezza 2010:1-43.

III. Medina-Gil C, Dehesa L, Vega A, Kerdel F. Prevalence of latent tuberculosis infection in patients with moderate to severe psoriasis taking biologic therapies in a dermatologic private practice in Miami, Florida. Int J Dermatol 2015;54:846-852.

IV. Roggero LS. La Salud Pública y las vacunas. Calendario Nacional de Vacunación. Departamento de Bioquímica Clínica; 2006.

V. Palacios Gutiérrez JJ. Diagnóstico de infección tuberculosa. Papel de los IGRAs. Bol Pediat 2011;51:123-126.

VI. Rodríguez Jiménez P, Mir-Viladrich I, Chicharro P, Solano-López G, et ál. Consenso multidisciplinar sobre prevención y tratamiento de la tuberculosis en pacientes candidatos a tratamiento biológico. Adaptación al paciente dermatológico. Actas Dermosifiliogr 2018;109:584-601.

VII. Kammüller M, Tsai TF, Griffiths CEM, Kapoor N, et ál.Secukinumab treatment shows no evidence of increased Mycobacterium tuberculosis infections. Clin Tansl Immunology 2017;6:152.

VIII. American Thoracic Society. Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med 2000;161:S221-S247.

IX. Mariette X, Vencovsky J, Lortholary O, Gómez-Reino J, et ál. The incidence of tuberculosis in patients treated with certolizumab pegol across indications: impact of baseline skin test results, more stringent screening criteria and geographic region. RMD Open 2015;1:1-11.

X. Cruz A, Ludovico P, Torrado E, Gama JB, ét al. IL-17A promotes intracellular growth of Mycobacterium by inhibiting apoptosis of infected macrophages. Front Immunol 2015;6:1-8.

Published

2019-06-25

Issue

Section

Clinical Cases