1 Hepato gastroenterology Department, Hassan II University Hospital Center, Fez, Morocco.
2 Radiology department, Hassan II University Hospital Center, Fez, Morocco.
Case Study
World Journal of Advanced Research and Reviews, 2024, 22(02), 547-554
Received on 28 March 2024; revised on 06 May 2024; accepted on 08 May 2024
Tuberculosis reactivation during anti-TNF-alpha therapy paradoxically worsened following reconstitution of pathogen-specific immune responses after cessation of TNFα antagonist treatment and initiation of anti-bacillary therapy. We report the case of a 46-year-old woman who was prescribed a tumor necrosis factor blocker (anti-TNF) for a relapse of Behçet's disease. The patient developed pulmonary miliary tuberculosis following the reactivation of latent tuberculosis, despite a normal pre-therapeutic work-up. Discontinuation of anti-TNF and initiation of anti-bacillary drugs triggered a paradoxical tubercular reaction (PTR). The diagnosis of paradoxical reaction to anti-tuberculosis drugs was evoked by the clinical and biological deterioration and the appearance of miliary cerebral tuberculosis and cerebral venous thrombosis after a period of clinical improvement. Although this phenomenon has been documented, it represents a major challenge for clinicians. The peculiarity of this case lies in its association with a macrophagic activation syndrome (MAS) with hepatic involvement, retained on clinical-biological and histological criteria. The overlap between MAS and PTR makes it difficult to diagnose these two entities with certainty. The patient responded favorably to moderate-dose systemic corticosteroid therapy with progressive degression, and the reintroduction of anti-tuberculosis drugs.This work aims to highlight the importance of close monitoring of TB patients on anti-TNFα therapy for early diagnosis and management of complications to improve the prognosis of these complex patients.
Macrophagic Activation Syndrome; Anti-Tnfα; The Paradoxical Tubercular Reaction; Behçet; Hepatic Manifestations; Miliary Tuberculosis
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Imane ATMANI, Maryame. el khayari, Soukaina Srhiri, Maria Lahlali, Asmae Lamine, Hakima Abid, Amine ElMekkaoui, Mounia El Yousfi, Dafrlah Benajah, Mohamed El Abkari, Adil Ibrahimi and Nada Lahmidani. Paradoxical tuberculous reaction to anti-tnfα discontinuation: a complex case of miliary tuberculosis and macrophagic activation syndrome with hepatic manifestations. World Journal of Advanced Research and Reviews, 2024, 22(2), 547-554. Article DOI: https://doi.org/10.30574/wjarr.2024.22.2.1388