Disseminated, fatal reactivation of bovine tuberculosis in a patient treated with adalimumab: a case report and review of the literature.

Mycobacterium bovis Adalimumab Bovine tuberculosis reactivation Non-necrotizing granulomas Tumour necrosis factor inhibitors

Journal

Infection
ISSN: 1439-0973
Titre abrégé: Infection
Pays: Germany
ID NLM: 0365307

Informations de publication

Date de publication:
14 Aug 2024
Historique:
received: 02 06 2024
accepted: 25 07 2024
medline: 15 8 2024
pubmed: 15 8 2024
entrez: 14 8 2024
Statut: aheadofprint

Résumé

Tumor necrosis factor inhibitors (TNFi) are known to increase the risk of tuberculosis (TB) reactivation, though cases involving Mycobacterium bovis are rarely reported. We describe a case of disseminated TB with M. bovis in a 78-year-old woman with a negative Interferon-Gamma-Release Assay (IGRA), taking adalimumab due to rheumatoid polyarthritis, which resulted in a fatal outcome. The atypical clinical and histopathological features were initially interpreted as sarcoidosis. The case occurred in Switzerland, an officially bovine tuberculosis-free country. The whole genome sequence of the patient's cultured M. bovis isolate was identified as belonging to the animal lineage La1.2, the main genotype in continental Europe, but showed significant genetic distance from previously sequenced Swiss cattle strains. In a literature review, four cases of bovine tuberculosis reactivation under TNFi treatment were identified, with pulmonal, oral and intestinal manifestations. Similar to our patient, two cases presented a negative IGRA before TNFi initiation, which later converted to positive upon symptomatic presentation of M. bovis infection. This case highlights the diagnostic challenges of TB in immunosuppressed patients, the limited sensitivity of IGRA, and the importance of considering TB reactivation even in regions declared free of bovine tuberculosis. Detailed patient histories, including potential exposure to unpasteurized dairy products, are essential for guiding preventive TB treatment before TNFi initiation.

Identifiants

pubmed: 39143434
doi: 10.1007/s15010-024-02364-0
pii: 10.1007/s15010-024-02364-0
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2024. The Author(s).

Références

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Auteurs

Gioele Capoferri (G)

Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland. gioele.capoferri@usb.ch.

Giovanni Ghielmetti (G)

Section of Veterinary Bacteriology, Institute for Food Safety and Hygiene, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.

Bettina Glatz (B)

Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.

Markus R Mutke (MR)

Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.

Alexandar Tzankov (A)

Institute of Pathology and Medical Genetics, University Hospital Basel, Basel, Switzerland.

Roger Stephan (R)

Section of Veterinary Bacteriology, Institute for Food Safety and Hygiene, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.

Peter M Keller (PM)

Division of Clinical Bacteriology and Mycology, University Hospital of Basel, Basel, Switzerland.

Niklaus D Labhardt (ND)

Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland.

Classifications MeSH