MILIARY TUBERCULOSIS AS A SEVERE ADVERSE REACTION TO THE USE OF ADALIMUMAB IN CROHN'S DISEASE: A CASE REPORT

Abstract

Introduction: Crohn's disease is an inflammatory bowel disease (IBD) that initiates a chronic idiopathic intestinal inflammatory process, leading to a variable clinical manifestations whose chronic diarrhea main symptom is. Diagnosis is built from a combination of clinical, laboratory and endoscopic data. When diagnosed, treatment may involve drug classes such as immunobiologicals. Regarding the use of immunobiologicals, such as adalimumab, one should be cautious due to its immunosuppressive effect, able to, in susceptible individuals, activate latent foci of infection, such as tuberculosis (TB). Objective: To report a case of miliary tuberculosis as an adverse reaction to the use of adalimumab and to make the medical community aware of the risks of administering immunobiological therapy. Case report: A 31-year-old male patient diagnosed with Crohn's Disease under outpatient follow-up with adalimumab as immunobiological therapy is admitted to the emergency department with acute respiratory and systemic symptoms. During the hospital investigation, despite the investigation of alcohol-acid resistant bacillus (BAAR) in sputum, the computerized tomography (CT) of the chest showed a pattern suggestive of miliary tuberculosis, in addition to a bronchoalveolar lavage with a positive test for Mycobacterium tuberculosis. Once the diagnosis of miliary TB was confirmed, treatment was started with rifampicin, isoniazid, pyrazinamide and ethambutol. Conclusion: Taking into account the high mortality and negative impacts of miliary tuberculosis, it is essential that all patients with IBD using immunobiologicals are screened for latent infection through chest radiography and PPD. However, even with regular screening and registration of previous vaccinations, the possibility of miliary tuberculosis cannot be ruled out in nonspecific clinical conditions in this patient profile.