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Teng Q, Fan B, Wang Y, Wen S, Wang H, Liu T, Wang L. Primary adrenal tuberculosis infection in patients with Behcet's disease presenting as isolated adrenal metastasis by 18F-FDG PET/CT: a rare case report and literature review. Gland Surg 2021; 10:3431-3442. [PMID: 35070903 PMCID: PMC8749099 DOI: 10.21037/gs-21-511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/05/2021] [Indexed: 07/30/2023]
Abstract
Primary adrenal tuberculosis (TB) is a rare type of extrapulmonary tuberculosis (EPTB). A pathological biopsy is usually required to make a definite diagnosis due to nonspecific symptoms. Antituberculous chemotherapy is the main treatment regimen, and cortisol replacement therapy should be added when adrenal insufficiency is involved. Here, we present a 59-year-old man who had recurrence of oral and genital aphthosis for 3 years and was diagnosed with Behcet's disease (BD), which was cured by thalidomide. After 10 days of admission, the patient had sudden abdominal pain in the right upper quadrant with high fever and was diagnosed with acute cholecystitis attack, which was treated by percutaneous transhepatic gallbladder drainage (PTGBD). Further contrast-enhanced CT showed a right adrenal mass with a diameter of 2.0 cm, and PET-CT indicated intense 18F-fluorodeoxyglucose (18F-FDG) uptake in the right adrenal mass with a maximum standardized uptake value (SUVmax) of 15.2. As a metastatic adrenal mass was suspected, the patient underwent retroperitoneal laparoscopic adrenalectomy. Histopathological and immunohistochemical analysis revealed primary adrenal TB. After routine anti-tuberculosis treatment with isoniazid, rifampin, pyrazinamide and ethambutol for six months, the patient was cured and discharged. In summary, primary unilateral adrenal TB without adrenal insufficiency is difficult to diagnose only on the basis of clinical manifestations and examinations. Further studies are needed to develop an easier and more accurate diagnostic examination.
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Affiliation(s)
- Qiliang Teng
- Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Bo Fan
- Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yutong Wang
- First Clinical College, Dalian Medical University, Dalian, China
| | - Shuang Wen
- Department of Pathology, Dalian Friendship Hospital, Dalian, China
| | - Honglong Wang
- Department of Pathology, Dalian Friendship Hospital, Dalian, China
| | - Tianqing Liu
- Department of Pathology, Dalian Friendship Hospital, Dalian, China
| | - Liang Wang
- Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian, China
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2
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Liu X, Zhang L, Zhang F, Zeng X, Zhao Y, Wang Q, Liu S, Zuo X, Zhang Z, Wu H, Chen S, Li H, Zhu P, Wu L, Qi W, Liu Y, Zhang M, Liu H, Xu D, Zheng W, Zhang Y, Shi X, Han L, Zhou Y, Zhao Y, Wang W, Li T, Tie N, Zhang K, Luo C, Gong B, Zhao Y, Lv C, Song L, Wu Q, Fei Y, Zhang L, Luo H, Sun J, Xue J, Gu L, Wang J, Han Q, Yimaity K, Zhou J, Zhao L, Bian S, Qi W, Li Y, Zhu Y, Han H, Liao S, Liu G. Prevalence and Risk Factors of Active Tuberculosis in Patients with Rheumatic Diseases: A Multi-center, Cross-Sectional Study in China. Emerg Microbes Infect 2021; 10:2303-2312. [PMID: 34753408 PMCID: PMC8654396 DOI: 10.1080/22221751.2021.2004864] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Evidence of active tuberculosis (ATB) in patients with rheumatic diseases are research priorities but limited data from China have been reported. Research targeting patients not taking anti-TNF biologics are especially insufficient. We aimed to investigate the prevalence and risk factors of ATB in this at-risk population. We conducted a tertiary hospital-based, multi-center, cross-sectional study by using stratified multi-stage cluster sampling strategy to screen ATB in patients with rheumatic diseases. We estimated the prevalence of ATB in patients with rheumatic diseases and identified risk factors among those who were not taking anti-TNF biologic. A total of 13,550 patients with rheumatic diseases were enrolled, and the result showed the standardized prevalence of ATB according to the composition ratio of various types of rheumatic disease was 882/100000 (95% confidence interval (CI): 706-1057). Multivariable logistic regression analysis in patients not taking anti-TNF biologics showed that the independent risk factors of ATB were having systemic lupus erythematosus (SLE) (OR=2.722, 95% CI: 1.437-5.159, p=0.002), having Behcet's disease (BD) (OR= 5.261, 95% CI: 2.071-13.365, p<0.001), taking azathioprine(AZA) within the past two years (OR=2.095, 95% CI: 0.986-4.450, p=0.054), exposing to glucocorticoids ≥30mg/d for more than four weeks within the past two years (OR=2.031, 95% CI: 1.247-3.309, p=0.004) and having evidences of previous TB (OR= 6.185, 95% CI: 3.487-10.969, p<0.001). The prevalence of ATB was higher in patients with rheumatic diseases compared to the general population. Patients with SLE or BD, prolonged exposure to moderate to high dose of glucocorticoids and previous TB were independent risk factors for ATB.
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Affiliation(s)
- Xiaoqing Liu
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,Centre for Tuberculosis Research, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,Clinical Epidemiology Unit, International Epidemiology Network, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Lifan Zhang
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,Centre for Tuberculosis Research, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,Clinical Epidemiology Unit, International Epidemiology Network, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Fengchun Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China
| | - Yan Zhao
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China
| | - Qian Wang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China
| | - Shengyun Liu
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoxia Zuo
- Department of Reumatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhiyi Zhang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Huaxiang Wu
- Department of Rheumatology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Sheng Chen
- Department of Rheumatology, Renji Hospital, Medical College of Shanghai Jiaotong University, Shanghai, China
| | - Hongbin Li
- Department of Rheumatology and Immunology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Ping Zhu
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Lijun Wu
- Department of Rheumatology, People Hospital of Xinjiang Uygur Autonomous Region, Urumchi, China
| | - Wencheng Qi
- Department of Rheumatology, Tianjin First Central Hospital, Tianjin, China
| | - Yi Liu
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Miaojia Zhang
- Department of Rheumatology, The first affiliated hospital of Nanjing Medical University, Nanjing, China
| | - Huaxiang Liu
- Department of Rheumatology, Qilu Hospital of Shandong University, Ji'nan, China
| | - Dong Xu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China
| | - Wenjie Zheng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China
| | - Yueqiu Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China
| | - Xiaochun Shi
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China
| | - Lishuai Han
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yaou Zhou
- Department of Reumatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yanping Zhao
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wenwen Wang
- Department of Rheumatology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Ting Li
- Department of Rheumatology, Renji Hospital, Medical College of Shanghai Jiaotong University, Shanghai, China
| | - Ning Tie
- Department of Rheumatology and Immunology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Kui Zhang
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Cainan Luo
- Department of Rheumatology, People Hospital of Xinjiang Uygur Autonomous Region, Urumchi, China
| | - Boqi Gong
- Department of Rheumatology, Tianjin First Central Hospital, Tianjin, China
| | - Yi Zhao
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Chengyin Lv
- Department of Rheumatology, The first affiliated hospital of Nanjing Medical University, Nanjing, China
| | - Lijun Song
- Department of Rheumatology, Qilu Hospital of Shandong University, Ji'nan, China
| | - Qingjun Wu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China
| | - Yunyun Fei
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China
| | - Lei Zhang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hui Luo
- Department of Reumatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jiaying Sun
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jing Xue
- Department of Rheumatology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Liyang Gu
- Department of Rheumatology, Renji Hospital, Medical College of Shanghai Jiaotong University, Shanghai, China
| | - Jing Wang
- Department of Rheumatology and Immunology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Qing Han
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Kuerbanjiang Yimaity
- Department of Rheumatology, People Hospital of Xinjiang Uygur Autonomous Region, Urumchi, China
| | - Jiaxin Zhou
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China
| | - Lidan Zhao
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China
| | - Sainan Bian
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China
| | - Wufang Qi
- Department of Rheumatology, Tianjin First Central Hospital, Tianjin, China
| | - Yanhong Li
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Yujing Zhu
- Department of Rheumatology, The first affiliated hospital of Nanjing Medical University, Nanjing, China
| | - Huijun Han
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Susu Liao
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Gaifen Liu
- China National Clinical Research Center for Neurological Diseases, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Zhong Z, Su G, Zhou Q, Meguro A, Takeuchi M, Mizuki N, Ohno S, Liao W, Feng X, Ding J, Gao Y, Chi W, Zhang M, Zuo X, Yang P. Tuberculosis Exposure With Risk of Behçet Disease Among Patients With Uveitis. JAMA Ophthalmol 2021; 139:415-422. [PMID: 33599689 DOI: 10.1001/jamaophthalmol.2020.6985] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Although experimental studies support the hypothesis that exposure of infectious agents may trigger an aberrant immune response and contribute to noninfectious uveitis, the association of a definite pathogen with human noninfectious uveitis conditions appears not to have been well established in a population. Objective To evaluate associations of tuberculosis infection with risk of several noninfectious uveitis conditions. Design, Setting, and Participants These mendelian randomization and observational analyses were conducted with the genetic data of a Chinese cohort enrolled between April 2008 and January 2018 and a Japanese cohort enrolled between January 2002 and June 2009. We recruited participants for T-SPOT.TB (Oxford Immunotec) assays between July and November 2019. The Chinese cohort included patients with uveitis associated with Behçet disease or other uveitis conditions and control participants. The Japanese cohort and the group given T-SPOT.TB assays included individuals with Behçet disease and control participants. Data analyses for this study were completed from July 2019 to January 2020. Exposures Genetic variants associated with tuberculosis as natural proxies for tuberculosis exposure. Main Outcomes and Measures The primary outcome was the odds ratio (OR) for Behçet disease, estimated by an inverse variance weighted mean of associations with genetically determined tuberculosis susceptibility. The T-SPOT.TB positivity rate was examined in individuals with Behçet disease and compared with that of control participants. Results The Chinese cohort included 999 patients with uveitis associated with Behçet disease, 1585 with other uveitis conditions, and 4417 control participants. The Japanese cohort included 611 individuals with Behçet disease and 737 control participants. The group given T-SPOT.TB assays included 116 individuals with Behçet disease and 121 control participants. Of the Chinese individuals with Behçet disease and control participants, 2257 (41.7%) were female and the mean (SD) age was 35.4 (12.5) years. In the Japanese cohort, 564 (41.8%) were female and the mean (SD) age was 39.1 (12.7) years. Genetically determined tuberculosis susceptibility was associated with an increased risk for Behçet disease. The OR for Behçet disease per 2-fold increase in tuberculosis incidence was 1.26 (95% CI, 1.12-1.43; P = 1.47 × 10-4). Replication using the Japanese cohort yielded similar results (OR, 1.16 [95% CI, 1.08-1.26]). In T-SPOT.TB assays, having a positive result, indicating a history of tuberculosis infection, was found to be an independent risk factor for Behçet disease (OR, 2.26 [95% CI, 1.11-4.60]). Conclusions and Relevance These human genetic and biomarker data demonstrated that tuberculosis exposure was a risk factor for Behçet disease. This study provides novel evidence linking an infectious agent to the risk of a noninfectious uveitis condition.
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Affiliation(s)
- Zhenyu Zhong
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guannan Su
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qingyun Zhou
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Akira Meguro
- Department of Ophthalmology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Masaki Takeuchi
- Department of Ophthalmology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Shigeaki Ohno
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Weiting Liao
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaojie Feng
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiadong Ding
- The First Affiliated Hospital of Zhengzhou University, Henan Province Eye Hospital, Zhengzhou, China
| | - Yingnan Gao
- The First Affiliated Hospital of Zhengzhou University, Henan Province Eye Hospital, Zhengzhou, China
| | - Wei Chi
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Meifen Zhang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xianbo Zuo
- The First Affiliated Hospital of Anhui Medical University, Institute of Dermatology, Anhui Medical University, Hefei, China
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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4
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Shen Y, Ma H, Luo D, Cai J, Zou J, Bao Z, Guan J. Behçet's disease with latent Mycobacterium tuberculosis infection. Open Med (Wars) 2020; 16:14-22. [PMID: 33336078 PMCID: PMC7718620 DOI: 10.1515/med-2021-0002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 11/15/2022] Open
Abstract
Objective The aim of this study is to examine the clinical features of patients with Behçet's disease (BD) in the presence or absence of latent tuberculosis infection (LTBI). Methods This was a retrospective study of 232 consecutive patients with active BD hospitalized between October 2012 and June 2017. LTBI was diagnosed based on the positive T-SPOT.TB assay, negative clinical, and imaging examinations. Results Among the 232 patients, 68 (29.3%) had LTBI. The frequency, number, and scope of oral ulcers in the BD-LTBI group were significantly more serious than in the non-LTBI group (all P < 0.05). Genital ulcers and eye involvement in the LTBI group were significantly higher than in the non-LTBI group (both P < 0.01). No active TB was diagnosed during follow-up (median, 27.9 months; range, 3-58 months). The patients with LTBI had signs of liver damage compared with the non-LTBI group. In the LTBI group, the frequency of alanine transaminase >2.0, the upper limit of normal, was higher in the rifampicin subgroup compared with the non-rifampicin subgroup (P = 0.033). Conclusion Patients with BD and LTBI had worse clinical features than those with BD without LTBI. Rifampicin might be associated with the damage to liver in BD patients combined with latent TB.
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Affiliation(s)
- Yan Shen
- Division of Rheumatology, Huadong Hospital, Fudan University, Shanghai 200040, China
| | - Haifen Ma
- Division of Rheumatology, Huadong Hospital, Fudan University, Shanghai 200040, China
| | - Dan Luo
- Division of Rheumatology, Huadong Hospital, Fudan University, Shanghai 200040, China
| | - Jianfei Cai
- Division of Rheumatology, Huadong Hospital, Fudan University, Shanghai 200040, China
| | - Jun Zou
- Division of Rheumatology, Huadong Hospital, Fudan University, Shanghai 200040, China
| | - Zhijun Bao
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital, Fudan University, Shanghai 200040, China
| | - Jianlong Guan
- Division of Rheumatology, Huadong Hospital, Fudan University, Shanghai 200040, China
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Wu X, Chen P, Wei W, Zhou M, Li C, Liu J, Zhao L, Zhang L, Zhao Y, Zeng X, Liu X, Zheng W. Diagnostic value of the interferon-γ release assay for tuberculosis infection in patients with Behçet's disease. BMC Infect Dis 2019; 19:323. [PMID: 30987605 PMCID: PMC6466763 DOI: 10.1186/s12879-019-3954-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 04/04/2019] [Indexed: 12/02/2022] Open
Abstract
Background To investigate the diagnostic value of the interferon-γ release assay (IGRA) for detecting tuberculosis (TB) infection in patients with Behçet’s disease (BD). Methods We retrospective analyzed the data collected from 173 BD patients hospitalized between 2010 and 2015. Ninety-nine healthy volunteers were enrolled as a control group. IGRA was performed using T-SPOT.TB. The diagnosis of active TB (ATB) was based on clinical, radiological, microbiological, histopathological information and the response to anti-TB therapy. Latent TB (LTB) infection was defined as asymptomatic patients with positive T-SPOT.TB. Results TB infection was documented in 59 BD patients (34.1%). The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of T-SPOT.TB for the diagnosis of ATB were 88.9%, 74.8%, 29.1%, 98.3%, 3.53 and 0.15, respectively. The receiver-operating-characteristic curve demonstrated that spot-forming cells (SFCs) of 70/106 PBMC was the optimal cutoff for diagnosing ATB, with an area under the curve of 0.891. Furthermore, the median SFCs in ATB group was significantly higher than those in LTB infection (466/106 PBMC vs. 68/106 PBMC, p = 0.007) or previous TB infection (466/106 PBMC vs. 96/106 PBMC, p = 0.018). A significant discrepancy between T-SPOT.TB and tuberculin skin test was noted (kappa coefficient = 0.391, p = 0.002). Conclusions T-SPOT.TB, an IGRA, may assist in the diagnosis of ATB in BD patients, and the higher SFCs suggest ATB in BD patients.
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Affiliation(s)
- Xiuhua Wu
- Department of Rheumatology and Clinical Immunology, Key Laboratory of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Ministry of Education, Beijing, China.,Department of Rheumatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Pang Chen
- Department of Rheumatology, Affiliated Mindong Hospital of Fujian Medical University, Fuan, Fujian, China
| | - Wei Wei
- Department of Rheumatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Mengyu Zhou
- Department of Rheumatology and Clinical Immunology, Key Laboratory of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Ministry of Education, Beijing, China
| | - Chaoran Li
- Department of Rheumatology and Clinical Immunology, Key Laboratory of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Ministry of Education, Beijing, China
| | - Jinjing Liu
- Department of Rheumatology and Clinical Immunology, Key Laboratory of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Ministry of Education, Beijing, China
| | - Lidan Zhao
- Department of Rheumatology and Clinical Immunology, Key Laboratory of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Ministry of Education, Beijing, China
| | - Lifan Zhang
- Department of Infectious Diseases, Clinical Epidemiology Unit, International Epidemiology Network, Centre for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Yan Zhao
- Department of Rheumatology and Clinical Immunology, Key Laboratory of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Ministry of Education, Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Key Laboratory of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Ministry of Education, Beijing, China
| | - Xiaoqing Liu
- Department of Infectious Diseases, Clinical Epidemiology Unit, International Epidemiology Network, Centre for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China.
| | - Wenjie Zheng
- Department of Rheumatology and Clinical Immunology, Key Laboratory of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Ministry of Education, Beijing, China.
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6
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Ozguler Y, Hatemi G, Ugurlu S, Seyahi E, Melikoglu M, Borekci S, Atahan E, Ongen G, Hamuryudan V. Re-initiation of biologics after the development of tuberculosis under anti-TNF therapy. Rheumatol Int 2016; 36:1719-1725. [PMID: 27699578 DOI: 10.1007/s00296-016-3575-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 09/28/2016] [Indexed: 11/26/2022]
Abstract
The use of anti-TNF agents is associated with an increased risk of tuberculosis (TB) and anti-TNF agents are stopped when active TB develops. However, discontinuation of treatment can result in flare of the underlying disease. The charts of 22 patients who developed active TB among a cohort of 2754 patients using anti-TNF agents between 2001 and 2013 were reviewed retrospectively. Patients restarting biologics during further follow-up were identified. One patient with miliary TB died within 1 month. A biologic agent was restarted in 16 of the remaining 21 patients (76 %). The most frequently re-initiated biologic agent was etanercept (n = 6) followed by rituximab (n = 5) and interferon-alpha (n = 3). Biologic treatment was re-initiated during anti-TB treatment in four patients and after completing TB treatment in 12 patients. The median follow-up after restarting biologics was 53 (IQR: 40-75) months. TB re-occurred in one patient with Behçet's syndrome, who initially received etanercept due to severe sight-threatening uveitis at the third month of anti-TB treatment followed by canakinumab 15 months later along with methotrexate, cyclosporine and corticosteroids. After a second course of 9 months TB therapy this patient is currently stable on interferon-alpha for 33 months. Restarting of anti-TNF agents and other biologic agents, even during TB treatment, seems to be possible among patients who had previously developed TB under anti-TNF treatment. However, the risk of re-development of TB infection mandates careful follow-up.
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Affiliation(s)
- Yesim Ozguler
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Fatih, Istanbul, 34098, Turkey
| | - Gulen Hatemi
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Fatih, Istanbul, 34098, Turkey
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Fatih, Istanbul, 34098, Turkey
| | - Emire Seyahi
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Fatih, Istanbul, 34098, Turkey
| | - Melike Melikoglu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Fatih, Istanbul, 34098, Turkey
| | - Sermin Borekci
- Department of Pulmonary Diseases, Cerrahpasa Medical Faculty, Istanbul University, Fatih, Istanbul, 34098, Turkey
| | - Ersan Atahan
- Department of Pulmonary Diseases, Cerrahpasa Medical Faculty, Istanbul University, Fatih, Istanbul, 34098, Turkey
| | - Gul Ongen
- Department of Pulmonary Diseases, Cerrahpasa Medical Faculty, Istanbul University, Fatih, Istanbul, 34098, Turkey
| | - Vedat Hamuryudan
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Fatih, Istanbul, 34098, Turkey.
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Hamuryudan V, Seyahi E, Ugurlu S, Melikoglu M, Hatemi G, Ozguler Y, Akman C, Tuzun H, Yurdakul S, Yazici H. Pulmonary artery involvement in Behçet׳s syndrome: Effects of anti-Tnf treatment. Semin Arthritis Rheum 2015; 45:369-73. [DOI: 10.1016/j.semarthrit.2015.06.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/01/2015] [Accepted: 06/12/2015] [Indexed: 01/20/2023]
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8
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Borekci S, Atahan E, Demir Yilmaz D, Mazıcan N, Duman B, Ozguler Y, Musellim B, Hamuryudan V, Ongen G. Factors affecting the tuberculosis risk in patients receiving anti-tumor necrosis factor-α treatment. Respiration 2015; 90:191-8. [PMID: 26137891 DOI: 10.1159/000434684] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 05/16/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Tumor necrosis factor (TNF)-α inhibitors are known to increase the risk of tuberculosis (TB). OBJECTIVES To examine the factors associated with an increased risk of TB in patients receiving anti-TNF-α treatment (aTNF-α-T). METHOD Of 3,094 patients who received aTNF-α-T between 2003 and 2013, a total of 1,964 subjects with a follow-up time longer than 6 months were identified and included in this retrospective analysis. Potential risk factors for the development of TB in patients receiving aTNF-α-T were evaluated. RESULTS Of the 1,964 patients, 1,009 (51%) were male and 955 (49%) were female, with a mean age of 39.7 ± 13.9 years. The primary conditions requiring aTNF-α-T included ankylosing spondylitis (n = 875), rheumatoid arthritis (n = 711), Behçet's disease (n = 83), and others (n = 295). Sixteen patients [8 (50%) males and 8 (50%) females; 5 (31.2%) with pulmonary TB and 11 (68.8%) with extrapulmonary TB] developed TB, with a corresponding TB incidence of 466/100,000. No significant associations were found between age, gender, smoking history, pack-years of smoking, isoniazid (INH) chemoprophylaxis, type of anti-TNF-α agent, use of other immunosuppressive drugs, and the risk of TB (p > 0.05). Multivariate logistic regression analysis showed a significantly higher risk of TB in patients diagnosed with Behçet's disease, and a significantly lower risk of TB in patients with a tuberculin skin test wheal ≥10 mm in diameter (p < 0.05). CONCLUSION aTNF-α-T is associated with an increased risk of pulmonary or extrapulmonary TB, even when follow-up protocols and INH chemoprophylaxis are implemented, and TB often develops in the later stages of treatment. The risk of TB was higher in patients with Behçet's disease and lower in patients who had a strong tuberculin skin test reaction.
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Affiliation(s)
- Sermin Borekci
- Department of Pulmonology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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9
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Pseudo-Behçet’s disease associated with tuberculosis: a case report and review of the literature. Rheumatol Int 2014; 34:1471-4. [DOI: 10.1007/s00296-014-2998-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 03/18/2014] [Indexed: 11/27/2022]
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10
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Fukui S, Takizawa Y, Kubota N, Okamoto T, Hishima T. Tuberculous lymphadenitis and the appearance of Behçet's disease-like symptoms. Intern Med 2014; 53:805-8. [PMID: 24694502 DOI: 10.2169/internalmedicine.53.1663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 48-year-old man visited our hospital complaining of a tender mass in the left side of the neck. He was diagnosed with tuberculous lymphadenitis based on the results of a biopsy. Shortly after the diagnosis, oral aphthae, erythema nodosum-like lesions on the lower legs and genital ulcers developed. A diagnosis of cutaneous tuberculosis was ruled out according to a negative mycobacterial culture of tissues obtained from stained smears and lesional biopsy specimens. The patient's symptoms remitted following the introduction of antituberculous therapy. We assume that tuberculous lymphadenitis was strongly associated with the appearance of Behçet's disease-like symptoms in this case.
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Affiliation(s)
- Shoichi Fukui
- Department of Connective Tissue Disease, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
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11
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Hamill M, Remedios D, Kapembwa M. Orogenital ulceration with overlapping tuberculosis: epiphenomenon or expanding spectrum of Behçet disease? J Low Genit Tract Dis 2006; 10:219-22. [PMID: 17012986 DOI: 10.1097/01.lgt.0000225897.29466.e4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Tuberculosis (TB) has rarely been reported in the context of Behçet disease. We present two cases of recurrent orogenital ulceration predating the onset of TB. No relapses of orogenital symptoms have occurred after successful TB chemotherapy.
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Affiliation(s)
- Matthew Hamill
- Department of Social and Cultural Anthropology, University of Oxford, Oxford, UK.
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12
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Hamuryudan V, Er T, Seyahi E, Akman C, Tüzün H, Fresko I, Yurdakul S, Numan F, Yazici H. Pulmonary artery aneurysms in Behçet syndrome. Am J Med 2004; 117:867-70. [PMID: 15589493 DOI: 10.1016/j.amjmed.2004.05.027] [Citation(s) in RCA: 148] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2004] [Accepted: 05/20/2004] [Indexed: 11/21/2022]
Affiliation(s)
- Vedat Hamuryudan
- Behçet's Syndrome Research Center, Cerrahpasa Medical Faculty, University of Istanbul, Istanbul, Turkey.
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13
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Affiliation(s)
- C M Magro
- Pathology Services Inc., Harvard Medical School, Cambridge, Massachusetts, USA
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