A case of ileorectal fistula due to intestinal tuberculosis and miliary tuberculosis caused by treatment with infliximab

Abstract

A 55-year-old woman was treated with infliximab for rheumatoid arthritis. She experienced general fatigue, and the results of a blood test showed worsening of anemia. Therefore, colonoscopy was performed, it showed an ulcerative lesion in the terminal ileum. A biopsy was performed, and a diagnosis to the of intestinal tuberculosis was made on the basis of biopsy findings. The results of chest CT were compatible with the findings associated with miliary tuberculosis. Sputum TB-PCR showed positive results for intestinal tuberculosis as well as miliary tuberculosis. Therefore, the patient was admitted to the hospital with a diagnosis of tuberculosis. From that time, she experienced increasing abdominal pain and frequent diarrhea. After adequate treatment of TB, she was referred for increased abdominal pain. CT showed cicatricial stenosis of the cecum, and surgery for the treatment of an ileorectal fistula was suggested. Ileocecal resection and rectal fistula closure were performed. She was discharged after 17 days without any major complications. Infliximab is known to aggravate tuberculosis, but reported cases of intestinal fistula formation are rare.