Abstract
A 72-year-old Japanese woman had had psoriatic arthritis since the age of 55. She was judged to need a biologic therapy, because her arthritis was so severe. A QuantiFERON-TB test indicated she had a latent tuberculosis infection (LTBI). She began to take isoniazid sodium methanesulfonate (600 mg/day) 22 days before the start of infliximab therapy and continued for 204 days. After the seventh course of the infliximab therapy (on 276th day after start of the therapy), she developed fever and general fatigue. Her serum CRP, CA125, and sIL-2R were increased to 14.14 mg/dl, 165.9 U/ml and 3,830 U/ml, respectively, and abdominal CT revealed ascites accumulation. Adenosine deaminase and CA125 in her ascites were increased to 111.7 U/l and 425.0 U/ml. Although staining and PCR of her ascites for TB were negative, laparoscopy revealed multiple white nodules and peritoneal adhesion. A histopathological examination of a peritoneal biopsy showed epithelioid cell granuloma with necrosis, and the biopsy’s PCR for TB was positive. These findings confirmed a diagnosis of tuberculous peritonitis, and anti-TB drugs (IHMS, RFP, EB, PZA) were started. The TB infection was cured promptly. Because dermatologists expect a new era of biological therapy for psoriasis, we must recognize the importance of tuberculosis prevention, early diagnosis and treatment.
