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Open Medicine

formerly Central European Journal of Medicine

Editor-in-Chief: Darzynkiewicz, Zbigniew

IMPACT FACTOR 2018: 1.221

CiteScore 2018: 1.01

SCImago Journal Rank (SJR) 2018: 0.329
Source Normalized Impact per Paper (SNIP) 2018: 0.479

ICV 2017: 152.94

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Volume 10, Issue 1


Volume 10 (2015)

Prolonged paradoxical reaction to antituberculous treatment after discontinuation of TNF-alpha- blocker therapy with adalimumab. Rare clinical documentation

Roger Fei Falkenstern-Ge / Kim Husemann
  • Division of Pulmonology, Klinik Schillerhoehe, Center for Pulmonology and Thoracic Surgery, Teaching Hospital of the University of Tuebingen, Solitude Str. 18, 70839 Stuttgart- Gerlingen, Germany
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/ Martin Kohlhäufl
  • Division of Pulmonology, Klinik Schillerhoehe, Center for Pulmonology and Thoracic Surgery, Teaching Hospital of the University of Tuebingen, Solitude Str. 18, 70839 Stuttgart- Gerlingen, Germany
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  • Other articles by this author:
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Published Online: 2014-10-08 | DOI: https://doi.org/10.1515/med-2015-0009


In the past decades, tumor necrosis factor alpha (TNF-a) antagonist has been a milestone in the treatment of many chronic inflammatory diseases. TNF antagonist can increase patients´ susceptibility to many different kinds of infections especially those requiring granuloma formations despite regular performance of Screening for latent tuberculosis infection (LTBI). We report 2 cases of patients who developed tuberculosis under treatment with adalimumab, which was discontinued after the diagnosis of tuberculosis. During the tuberculosis therapy they unexpectedly developed a prolonged paradoxical reaction. In both cases we were only able to manage the progress of the paradoxical reaction through high steroid doses. Patients undergoing therapy with TNF- alphablocker are prone to develop tuberculosis infection, which could in turn lead to severe prolonged paradoxical reaction during anti-tuberculous treatment. An increased steroid dose may be required and is sometimes necessary

Keywords : Adalimumab; Paradoxical reaction; IRIS (immune reconstitution inflammatory syndrome); SAPHO (synovitis; acne; pustulosis; hyperostosis; osteitis) syndrome; latent tuberculosis infection (LTBI); Tuberculosis (TB); IGRA (Interferon Gamma Release Assay); TNF (tumor necrosis factor)


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About the article

Received: 2013-04-28

Accepted: 2014-01-08

Published Online: 2014-10-08

Published in Print: 2015-01-01

Citation Information: Open Medicine, Volume 10, Issue 1, ISSN (Online) 2391-5463, DOI: https://doi.org/10.1515/med-2015-0009.

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© 2015 R.F. Falkenstern-Ge et al.. This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License. BY-NC-ND 3.0

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