Tuberculous Tonsillitis in a Patient Treated with an Anti-TNF Ag

  • Sara Ferreira Centro Hospitalar de S. João, Serviço de Medicina Interna
  • Paula Vaz-Marques Centro Hospitalar S. João, Serviço de Medicina Interna
Keywords: Tuberculous tonsillitis, adalimumab

Abstract

Tuberculosis remains a concern in patients receiving anti-TNF therapy as these individuals have a higher incidence of extrapulmonary and disseminated tuberculosis. Tuberculous tonsillitis is an unusual presentation of extrapulmonary tuberculosis, which is diagnosed mostly in immunodeficient patients. We report the case of a 33-year-old woman, diagnosed with Behçet’s syndrome, immunosuppressed with adalimumab, cyclosporine and prednisolone. She had odynophagia for 2 weeks, fever and a hypertrophied, ulcerated left tonsil. A tonsil biopsy revealed a granulomatous inflammatory process. Ziehl-Neelsen staining was positive for acid-fast bacilli. The chest x-ray revealed a milliary pattern. Gastric juice was positive for Mycobacterium tuberculosis complex DNA. A diagnosis of tonsillar and pulmonary tuberculosis was established. This case report highlights the low threshold for a tuberculosis diagnosis in unusual locations in patients treated with anti-TNF therapy. 

References

  • Armuzzi A, Lionetti P, Blandizzi C, Caporali R, Chimenti S, Cimino L, et al. Anti-TNF agents as therapeutic choice in immune-mediated inflammatory diseases: focus on adalimumab. Int J Immunopathol Pharmacol 2014;27:11–32.

  • Rifkin LM, Birnbaum AD, Goldstein DA. TNF inhibition for ophthalmic indications: current status and outlook. BioDrugs 2013;27:347–357.

  • Nacci F, Matucci-Cerinic M. Tuberculosis and other infections in the anti-tumour necrosis factor-alpha (anti-TNF-α) era. Best Pract Res Clin Rheumatol 2011;25:375–388.

  • Sutbeyaz Y, Ucuncu H, Murat Karasen R, Gundogdu C. The association of secondary tonsillar and laryngeal tuberculosis: a case report and literature review. Auris Nasus Larynx 2000;27:371–374.

  • Carmona L, Gómez-Reino JJ, Rodríguez-Valverde V, Montero D, Pascual-Gómez E, Mola EM, et al. Effectiveness of recommendations to prevent reactivation of latent tuberculosis infection in patients treated with tumor necrosis factor antagonists.Arthritis Rheum 2005;52:1766-1772.
  • Published: 2017-10-30

    Issue: Vol 4 No 8 (view)

    Section: Articles

    How to cite:
    Ferreira, S., & Vaz-Marques, P. (2017, October 30). Tuberculous Tonsillitis in a Patient Treated with an Anti-TNF Ag. European Journal of Case Reports in Internal Medicine, 4(8). https://doi.org/https://doi.org/10.12890/2017_000690