PT - JOURNAL ARTICLE AU - Liliana Alexandrina Grigoriu AU - Cristina Iacobescu AU - Ana Maria Sasu AU - Stefan Dumitrache-Rujinski AU - Miron Alexandru Bogdan TI - Miliary tuberculosis during treatment with anti TNF alpha - A report of three cases DP - 2012 Sep 01 TA - European Respiratory Journal PG - P2585 VI - 40 IP - Suppl 56 4099 - http://erj.ersjournals.com/content/40/Suppl_56/P2585.short 4100 - http://erj.ersjournals.com/content/40/Suppl_56/P2585.full SO - Eur Respir J2012 Sep 01; 40 AB - The anti-TNFs α have proven very effective in the treatment of rheumatoid arthritis, ankylosing spondylitis, psoriasis, Crohn's disease. Among the side effects is well known the risk of developing infections, particularly tuberculosis. We present three cases of miliary tuberculosis with mediastinal lymphadenopathy which occurred during treatment with anti-TNFα. Two male patients aged 56 respectively 41 years, were treated with infliximab for ankylosing spondylitis. One male patient aged 32 years was treated with adalimumab for psoriasis. All patients performed chest X-ray, tuberculin skin test, quantiferon TB test for latent TB. The clinical signs of disease were febrile syndrome, dyspnoea, cough and weight loss. In the first case, the positive diagnosis was concluded on lung biopsy and culture positive for BK in sputum. In the second case, were revealed AFB in bronchial aspirate. In the third case, the diagnosis was concluded on lung and mediastinal lymphnode biopsy. In all cases we observe an aspect of miliary and mediastinal lymphadenopathy on chest CT. In the first case, we find a pulmonary embolism. All three patients developed hepatic cytolysis during anti TB treatment, requiring discontinuation in two cases. The evolution was slowly favorable after the reintroduction of treatment. Conclusions: All three cases are severe forms of miliary tuberculosis associating necrotic mediastinal lymphnodes occurred during treatment with anti TNFα. There was a dramatic clinical syndrome with persistent fever and significant weight loss in the second case. The regression of pulmonary and mediastinal lesions has been very slow.