Development of Spinal Tuberculosis in an Adolescent With Crohn's Disease After Infliximab Therapy: A Case Report With Literature Review
IntroductionTuberculosis (TB) spondylitis, also known as Pott's disease, is a severe form of extrapulmonary TB. Infliximab treatment for Crohn's disease (CD) patients increases the risk of TB, and is likely to increase the risk of TB spondylitis as well.Case PresentationWe report a rare ca...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-02-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2021.802298/full |
| _version_ | 1819274327452811264 |
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| author | Jae Hoon Jung Sujin Choi Youra Kang Dae-Chul Cho So Mi Lee Tae In Park Byung-Ho Choe Dongsub Kim Ben Kang |
| author_facet | Jae Hoon Jung Sujin Choi Youra Kang Dae-Chul Cho So Mi Lee Tae In Park Byung-Ho Choe Dongsub Kim Ben Kang |
| author_sort | Jae Hoon Jung |
| collection | DOAJ |
| description | IntroductionTuberculosis (TB) spondylitis, also known as Pott's disease, is a severe form of extrapulmonary TB. Infliximab treatment for Crohn's disease (CD) patients increases the risk of TB, and is likely to increase the risk of TB spondylitis as well.Case PresentationWe report a rare case of TB spondylitis development in a 16-year-old female with CD. She had a close household contact of active pulmonary TB and received contact investigation. She was diagnosed with latent TB 1 month before the diagnosis of CD, and had started a latent TB treatment regimen with isoniazid for 9 months. At 5 months from the start of latent TB treatment, infliximab was started. Approximately 1 year after infliximab treatment, her infusion interval was shortened from every 8 weeks to every 4 weeks owing to secondary loss of response due to nonimmunogenic pharmacokinetic failure. One month later, miliary TB developed and infliximab was stopped. She received a miliary TB treatment regimen for 6 months, curing the disease. Three months later, spinal TB was incidentally detected on abdominal computed tomography. She received a TB treatment regimen for 12 months, curing spinal TB. Currently, she is receiving vedolizumab to treat CD and is in clinical remission. Although this patient has sufficiently been treated at each stage of TB development, particularly for latent TB and miliary TB, TB spondylitis still developed.ConclusionConsidering that TB spondylitis developed despite sufficient treatment at each stage, pediatric gastroenterologists should stay cautious when using anti-tumor necrosis factor agents in patients with inflammatory bowel disease with a history of latent TB. |
| first_indexed | 2024-12-23T23:06:40Z |
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| language | English |
| last_indexed | 2024-12-23T23:06:40Z |
| publishDate | 2022-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-ccab1625ca8d4e61afda3c40aaf790512022-12-21T17:26:47ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602022-02-01910.3389/fped.2021.802298802298Development of Spinal Tuberculosis in an Adolescent With Crohn's Disease After Infliximab Therapy: A Case Report With Literature ReviewJae Hoon Jung0Sujin Choi1Youra Kang2Dae-Chul Cho3So Mi Lee4Tae In Park5Byung-Ho Choe6Dongsub Kim7Ben Kang8Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, South KoreaDepartment of Pediatrics, School of Medicine, Kyungpook National University, Daegu, South KoreaDepartment of Pediatrics, School of Medicine, Kyungpook National University, Daegu, South KoreaDepartment of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, South KoreaDepartment of Radiology, School of Medicine, Kyungpook National University, Daegu, South KoreaDepartment of Pathology, School of Medicine, Kyungpook National University Daegu, South KoreaDepartment of Pediatrics, School of Medicine, Kyungpook National University, Daegu, South KoreaDepartment of Pediatrics, School of Medicine, Kyungpook National University, Daegu, South KoreaDepartment of Pediatrics, School of Medicine, Kyungpook National University, Daegu, South KoreaIntroductionTuberculosis (TB) spondylitis, also known as Pott's disease, is a severe form of extrapulmonary TB. Infliximab treatment for Crohn's disease (CD) patients increases the risk of TB, and is likely to increase the risk of TB spondylitis as well.Case PresentationWe report a rare case of TB spondylitis development in a 16-year-old female with CD. She had a close household contact of active pulmonary TB and received contact investigation. She was diagnosed with latent TB 1 month before the diagnosis of CD, and had started a latent TB treatment regimen with isoniazid for 9 months. At 5 months from the start of latent TB treatment, infliximab was started. Approximately 1 year after infliximab treatment, her infusion interval was shortened from every 8 weeks to every 4 weeks owing to secondary loss of response due to nonimmunogenic pharmacokinetic failure. One month later, miliary TB developed and infliximab was stopped. She received a miliary TB treatment regimen for 6 months, curing the disease. Three months later, spinal TB was incidentally detected on abdominal computed tomography. She received a TB treatment regimen for 12 months, curing spinal TB. Currently, she is receiving vedolizumab to treat CD and is in clinical remission. Although this patient has sufficiently been treated at each stage of TB development, particularly for latent TB and miliary TB, TB spondylitis still developed.ConclusionConsidering that TB spondylitis developed despite sufficient treatment at each stage, pediatric gastroenterologists should stay cautious when using anti-tumor necrosis factor agents in patients with inflammatory bowel disease with a history of latent TB.https://www.frontiersin.org/articles/10.3389/fped.2021.802298/fullPott's diseaseCrohn's diseasetuberculosistumor necrosis factorinfliximabvedolizumab |
| spellingShingle | Jae Hoon Jung Sujin Choi Youra Kang Dae-Chul Cho So Mi Lee Tae In Park Byung-Ho Choe Dongsub Kim Ben Kang Development of Spinal Tuberculosis in an Adolescent With Crohn's Disease After Infliximab Therapy: A Case Report With Literature Review Frontiers in Pediatrics Pott's disease Crohn's disease tuberculosis tumor necrosis factor infliximab vedolizumab |
| title | Development of Spinal Tuberculosis in an Adolescent With Crohn's Disease After Infliximab Therapy: A Case Report With Literature Review |
| title_full | Development of Spinal Tuberculosis in an Adolescent With Crohn's Disease After Infliximab Therapy: A Case Report With Literature Review |
| title_fullStr | Development of Spinal Tuberculosis in an Adolescent With Crohn's Disease After Infliximab Therapy: A Case Report With Literature Review |
| title_full_unstemmed | Development of Spinal Tuberculosis in an Adolescent With Crohn's Disease After Infliximab Therapy: A Case Report With Literature Review |
| title_short | Development of Spinal Tuberculosis in an Adolescent With Crohn's Disease After Infliximab Therapy: A Case Report With Literature Review |
| title_sort | development of spinal tuberculosis in an adolescent with crohn s disease after infliximab therapy a case report with literature review |
| topic | Pott's disease Crohn's disease tuberculosis tumor necrosis factor infliximab vedolizumab |
| url | https://www.frontiersin.org/articles/10.3389/fped.2021.802298/full |
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