阿达木单抗治疗银屑病致播散性肺结核一例并文献复习  

A case of disseminated tuberculosis induced by adalimumab in the treatment of psoriasis and literatures review

作　　者：李可心 鲁瑞 田燕 王文俊 李维[2] 万月强 翟嵩[1] 刘拉羊[1] Li Kexin;Lu Rui;Tian Yan;Wang Wenjun;Li Wei;Wan Yueqiang;Zhai Song;Liu Layang(Department of Infectious Diseases,The Second Affliated Hospital of Xi'an Jiaotong University,Xi'an 710004,China;Department of Respiratory and Critical Care Medicine,The Second Affliated Hospital of Xi'an Jiaotong University,Xi'an 710004,China;Tuberculosis Hospital of Shaanxi Province,Xi'an 710105,China)

机构地区：[1]西安交通大学第二附属医院感染科,西安市710004 [2]西安交通大学第二附属医院呼吸科,西安市710004 [3]陕西省结核病防治院,西安市710100

出　　处：《中华实验和临床感染病杂志（电子版）》2024年第4期245-249,共5页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：陕西省自然科学基金(面上)项目(No.2020JM-408)。

摘　　要：目的探讨阿达木单抗诱发潜伏性结核感染再激活的诊疗及预防。方法回顾性分析西安交通大学第二附属医院2023年3月收治的1例31岁男性患者应用阿达木单抗治疗银屑病致播散性肺结核的临床资料,并检索国内外相关文献,对该病的发病机制、临床特征及诊疗进行探讨。结果患者既往有银屑病病史3年,发病前半年接受“阿达木单抗”治疗;以“发热、干咳”起病,入院后结合患者生物制剂用药史、发热及干咳症状、肺部粟粒性改变和肿大淋巴结、结核分枝杆菌感染免疫学和病原学阳性结果,诊断为播散性肺结核。启动异烟肼(300mg、1次/d)+利福平(600mg、1次/d)+吡嗪酰胺(500mg、3次/d)+乙胺丁醇(1000mg、1次/d)抗结核治疗,同时联合静脉滴注莫西沙星(400mg、1次/d)治疗后体温降至正常,咳嗽消失。随访5个月,无发热、咳嗽,复查胸部CT提示两肺弥漫多发粟粒样结节消失。结论使用包括阿达木单抗在内的TNF-α拮抗剂治疗过程中需密切监测患者症状、体征、胸片,加强用药前评估和用药过程监测,有助于预防或及早干预阿达木单抗所致的结核分枝杆菌感染或再激活。Objective To investigate the diagnosis,treatment and prevention of reactivation of latent tuberculosis infection induced by adalimumab.Methods Clinical data of a 31 years old male patient with disseminated pulmonary tuberculosis caused by adalimumab during the treatment of psoriasis in the Second Affiliated Hospital of Xi'an Jiaotong University in March 2023 was analyzed,retrospectively.Relevant literatures were searched to explore the pathogenesis,clinical characteristics,diagnosis and treatment of the disease.Results The patient has been suffering psoriasis for 3 years and received treatment with adalimumab six months before the onset of the disease.Starting with fever and dry cough,the patient was diagnosed as disseminated pulmonary tuberculosis after admission based on a history of using biological agents,symptoms of fever and dry cough,pulmonary miliary changes,enlarged lymph nodes,and positive results in immunology and pathogen of tuberculosis infection.After the initiate anti-tuberculosis treatment with isoniazid(300 mg,once a day),rifampicin(600 mg,once a day),pyrazinamide(500 mg,3 times a day)and ethambutol(1000 mg,once a day),and combined intravenous injection moxifloxacin(400 mg,once a day),the patient's body temperature dropped to normal and cough disappeared.Follow-up was performed for 5 months,the patient did not have a fever or cough;repeated chest CT showed diffuse multiple miliary nodules disappeared in both lungs.Conclusions During the process of TNF-αantagonist therapy including adalimumab,it is necessary to closely monitor the symptoms,signs,chest X-ray,and to strengthen the pre-medication evaluation and monitoring during medication,process,which can contribute to prevent or intervene early in tuberculosis infection or reactivation caused by adalimumab.

关 键 词：阿达木单抗 播散性肺结核 潜伏结核感染 银屑病 

分 类 号：R521[医药卫生—内科学]