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2005, Número 1

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Rev Inst Nal Enf Resp Mex 2005; 18 (1)


Dos casos de reactivación de tuberculosis pulmonar por infliximab: Problemas y propuestas de solución

Díaz VMJ

Idioma: Español
Referencias bibliográficas: 50
Paginas: 27-35
Archivo PDF: 158.88 Kb.


RESUMEN

Introducción: Se han descrito múltiples factores de riesgo para el desarrollo de la tuberculosis; uno recientemente conocido es la inmunosupresión secundaria al uso de infliximab, anticuerpo monoclonal quimérico antifactor de necrosis tumoral-a usado en enfermos con artritis reumatoide o espondilitis anquilosante refractarias a tratamiento y en enfermedad de Crohn fistulizante, entre otros, en los que se ha comunicado reactivación tuberculosa en Estados Unidos y Europa.
Presentación de casos: En México sólo se conoce un caso. Presentamos dos más en enfermos con espondiloartropatías HLA-B27 refractarios a tratamiento modificador de la enfermedad. Uno en una mujer de 23 años, después de la segunda dosis de infliximab; otro en un hombre de 32 años, después de la quinta dosis, a la semana 22 de tratamiento. Ambos presentaron forma neumónica cavitada con buena respuesta al tratamiento antituberculoso acortado convencional y suspensión del infliximab.
Discusión: La revisión bibliográfica incluye el impacto de los problemas: infliximab-reactivación tuberculosa y la epidemiología tuberculosa actual, medidas preventivas, controversias en detección, tratamiento y fisiopatología de la relación infliximab-reactivación tuberculosa para proponer medidas para su diagnóstico, vigilancia y manejo de nuevos casos aplicables en nuestro entorno.


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