Abstract
This article presents two consecutive cases of laryngeal tuberculosis in patients treated with a specific anti-tumour necrosis factor-alpha (adalimumab), with a focus on their diagnostic process and therapeutic management. Both patients presented with aspecific chronic laryngeal symptoms that had been worsening for a few months in one case and for almost 1 year in the other one. They were both studied with fibreoptic laryngoscopy and contrast-enhanced CT and MRI scans. In both cases, the laryngeal biopsy proved negative to Ziehl-Neelsen test, while positive to Koch’s bacillus sensitive to rifampicin at PCR test. Both patients completely responded to standard antitubercular antibiotic therapy with rifampicin, isoniazid, pyrazinamide and etambutol protocol.In the differential diagnosis of such patients, laryngeal tuberculosis should be considered due to the reasonable linkage between the immunosuppressant therapy with adalimumab and the tuberculosis infection/reactivation.
Reference15 articles.
1. Laryngeal tubercolosis: A case report with focus on voice assessment and review of the literature;Migliorelli;Acta Otorhinolaryngol Ital,2022
2. Risk of tuberculosis reactivation with interleukin (IL) ‐17 and IL‐23 inhibitors in psoriasis – time for a paradigm change;Nogueira;J Eur Acad Dermatol Venereol,2021
3. Brett K , Dulong C , Severn M . Treatment of tuberculosis: A review of guidelines (ON): canadian agency for drugs and technologies in health; 2020 [cited 7 february 2022]. (CADTH rapid response reports) Internet. Ottawa, Available: http://www.ncbi.nlm.nih.gov/books/NBK562947/
4. Reactivation of latent tuberculosis with TNF inhibitors: critical role of the beta 2 chain of the IL-12 receptor;Robert;Cell Mol Immunol,2021
5. Risk of tuberculosis infection in anti-TNF-α biological therapy: from bench to bedside;Xie;Journal of Microbiology, Immunology and Infection,2014