The importance of tuberculosis screening prior to the administration of anti-TNF-¿ agents for uveitis: On the purpose of a clinical case Importancia del escrutinio para tuberculosis previo a la administración de agentes anti-TNF-¿ en uveítis: A propósito de un caso clínico
Academic Article in Scopus
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© 2014 Sociedad Mexicana de Oftalmología. Introduction: Over the last decade, there has been an increased in the incidence of latent tuberculosis reactivation associated with the use of anti-tumor necrosis factor alpha (TNF-¿), particularly infliximab (Remicade®). Actually, these biologic agents are used more frequently to control the inflammatory response of different systemic immune disorders. Clinical case: We present herein the case of a 30 year-old male with the diagnosis of juvenile idiopathic arthritis (JIA), who developed extrapulmonar (intestinal) tuberculosis diagnosed by mesenteric ganglion biopsy, who required anti-tuberculosis therapy after he was started on infliximab therapy for JIA. Moreover, he developed uveitis unrelated to JIA, but rather attributed to reactivation of tuberculosis in the form of vitritis and anterior chamber granulomatous inflammation characterized by large KPs formation. Conclusion: It is mandatory to perform screening tests for latent tuberculosis before starting treatment with anti-TNF-¿, particularly with infliximab. Tests that measure gamma interferon (IFN-¿) in vitro in response to tuberculous antigens are an alternative to the classic tuberculin skin test (PPD) to detect active tuberculosis, particularly in individuals vaccinated with the Calmette-Guerin (BCG) bacillus.