TY - JOUR T1 - Miliary tuberculosis during treatment with anti TNF alpha - a report of four cases JF - European Respiratory Journal JO - Eur Respir J VL - 42 IS - Suppl 57 SP - P4455 AU - Liliana Alexandrina Grigoriu AU - Cristina Iacobescu AU - Ana Maria Sasu AU - Stefan Rujinski AU - Adriana Moisoiu AU - Miron Alexandru Bogdan Y1 - 2013/09/01 UR - http://erj.ersjournals.com/content/42/Suppl_57/P4455.abstract N2 - The anti-TNFs alpha have proven 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 four cases of miliary tuberculosis with mediastinal lymphadenopathy which occurred during treatment with anti-TNF alpha, diagnosed in 7 Department of “M Nasta” Institute of Pneumology in 2011-2012. Two male patients aged 56 and 41 years, were treated with infliximab for ankylosing spondylitis. One male patient aged 32 and one female aged 47 years were 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 performed on lung biopsy and culture positive for BK in sputum. In the second case, were revealed AFB in bronchial aspirate. In the third and fourth case, the diagnosis was performed on lung and mediastinal lymphnode biopsy. In all cases we observe an aspect of miliary and mediastinal lymphadenopathy on chest CT. Three patients developed hepatic cytolysis during anti TB treatment. The evolution was slowly favorable in three cases and complicated with bone TB, psoas abscess, meningitis TB and death in one case, proved with HRS chemoresistance. Conclusions: All four cases are severe forms of miliary tuberculosis occurred during treatment with anti TNF alpha. There was a dramatic clinical syndrome with persistent fever, significant weight loss and death in one case. The regression of pulmonary and mediastinal lesions has been very slow. ER -