PReS-FINAL-2250: Presentation of tuberculosis in patients using anti-TNFS drugs: report of 3 cases

Methods: Case Report Case 1: Female patient, 20 yo, with back pain for two years, right sacroiliitis confirmed by scintigraphy and biopsy. She was treated with indomethacin, prednisone, sulfasalazine and metotretaxe showing no significant improvement for one year. Etanercept was initiated with prior normal chest Rx and negative PPD. After 7 months of use, the patient presented fever associated to pleural effusion in the right hemithorax. The biopsy was consistent with pleural tuberculosis. She was treated with rifampicin, isoniazid, pyrazinamide and streptomycin with complete recovery of pulmonary infection. Case 2: Female patient, 5 years old with juvenile idiopathic arthritis (JIA) polyarticular RF negative. Initially treated with naproxen, methotrexate, prednisone, and folic acid without clinical improvement. After 6 months of treatment, it was initiated infliximab, with prior normal chest Rx and negative PPD with control of the joint symptoms. After 7 months of use, the patient developed severe pneumonic miliary tuberculosis. She was treated with rifampicin, isoniazid, pyrazinamide. The patient resolved her pulmonary infection and remains in remission of JIA, after 7 years of follow-up. Case 3: Male patient, 17 years old, ankylosing spondylitis for 3 years, treated with methotrexate, naproxen, sulfasalazine and prednisone with poor response. He was started on infliximab for 6 years until he presented productive cough with headache and fever, CXR was consistent with pulmonary tuberculosis. He was treated with rifampicin, isoniazid, pyrazinamide for 6 months. The iTNF was changed for adalimumab with control of the disease.