Pulmonary miliary tuberculosis in a patient with anti-TNF-alpha treatment

Scand J Rheumatol. 2002;31(1):44-5. doi: 10.1080/030097402317255372.


No difference in the number of serious adverse events was reported in previous clinical trials in rheumatoid arthritis (RA) and inflammatory bowel disease (IBD) patients treated with TNF-alpha blockade, but a patient died because of disseminated tuberculosis. A tuberculosis reactivation in a patient with IBD and anti-TNF-alpha treatment has been recently reported. Very recently 70 cases of tuberculosis were reported from the FDA Adverse Event Reporting System. We report a case of pulmonary miliary tuberculosis in a RA patient treated with TNF-alpha blockade. The important role of TNF-alpha in defence against tuberculosis and possible mechanisms of anti-TNF-alpha agents impairing tuberculosis immune response are discussed.

Publication types

  • Case Reports

MeSH terms

  • Antibodies, Monoclonal / adverse effects*
  • Arthritis, Rheumatoid / drug therapy
  • Arthritis, Rheumatoid / immunology
  • Female
  • Humans
  • Immunocompromised Host
  • Immunosuppressive Agents / adverse effects*
  • Infliximab
  • Lung / diagnostic imaging
  • Mycobacterium tuberculosis / isolation & purification
  • Tomography, X-Ray Computed
  • Tuberculosis, Miliary / chemically induced*
  • Tuberculosis, Miliary / immunology
  • Tuberculosis, Miliary / pathology
  • Tuberculosis, Pulmonary / chemically induced*
  • Tuberculosis, Pulmonary / immunology
  • Tuberculosis, Pulmonary / pathology
  • Tumor Necrosis Factor-alpha / immunology*


  • Antibodies, Monoclonal
  • Immunosuppressive Agents
  • Tumor Necrosis Factor-alpha
  • Infliximab