Share This Article:

Tuberculous Peritonitis Mimicking Malignancy during Adalimumab Therapy in a Patient with Rheumatoid Arthritis

Full-Text HTML XML Download Download as PDF (Size:331KB) PP. 72-76
DOI: 10.4236/jtr.2015.33011    2,602 Downloads   2,894 Views  


We present a case of tuberculous peritonitis in a 46-year-old woman with rheumatoid arthritis treated with adalimumab, and we review the association between anti-tumour necrosis factor therapy and tuberculosis. This case illustrates that tuberculosis can develop with atypical clinic and uncertain laboratory findings and may mimic malignancies during adalimumab therapy.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Demirtunç, R. , Özensoy, U. , Kayataş, K. and Aker, F. (2015) Tuberculous Peritonitis Mimicking Malignancy during Adalimumab Therapy in a Patient with Rheumatoid Arthritis. Journal of Tuberculosis Research, 3, 72-76. doi: 10.4236/jtr.2015.33011.


[1] Toussirot, E., Streit, G. and Wendling, D. (2007) Infectious Complications with Anti-TNFalpha Therapy in Rheumatic Diseases: A Review. Recent Patents on Inflammation & Allergy Drug Discovery, 1, 39-47.
[2] Olsen, N.J., Michael Stein, C. and Ch.B., M.B. (2004) New Drugs for Rheumatoid Arthritis. New England Journal of Medicine, 350, 2167-2179.
[3] Antolín, J., Azahara, M., Hernández, C., Blanco, M., Mao, L. and Cigüenza, R. (2008) Scand Tuberculous Peritonitis after Treatment with Adalimumab. Journal of Infectious Diseases, 40, 677-678.
[4] Yoo, I.K., Choung, R.S., Hyun, J.J., Kim, S.Y., Jung, S.W., Koo, J.S., et al. (2014) Incidences of Serious Infections and Tuberculosis among Patients. Yonsei Medical Journal, 55, 442-448.
[5] Saunders, B.M., Briscoe, H. and Britton, W.J. (2004) T Cell-Derived Tumour Necrosis Factor Is Essential, but Not Sufficient, for Protection against Mycobacterium tuberculosis Infection. Clinical & Experimental Immunology, 137, 279-287.
[6] Flynn, J.L., Goldstein, M.M., Chan, J., Triebold, K.J., Pfeffer, K., Lowenstein, C.J., et al. (1995) Tumor Necrosis Factor-Alpha Is Required in the Protective Immune Response against Mycobacterium tuberculosis in Mice. Immunity, 2, 561-572.
[7] Harris, J., Hope, J.C. and Keane, J. (2008) Tumor Necrosis Factor Blockers Influence Macrophage Responses to Mycobacterium tuberculosis. Journal of Infectious Diseases, 198, 1842-1850.
[8] Algood, H.M., Lin, P.L., Yankura, D., Jones, A., Chan, J. and Flynn, J.L. (2004) TNF Influences Chemokine Expression of Macrophages in Vitro and That of CD11b+ Cells in Vivo during Mycobacterium tuberculosis Infection. Journal of Immunology, 172, 6846-6857.
[9] Zhou, Z., Connell, M.C. and MacEwan, D.J. (2007) TNFR1-Induced NF-KappaB, but Not ERK, p38MAPK or JNK Activation, Mediates TNF-Induced ICAM-1 and VCAM-1 Expression on Endothelial Cells. Cell Signal, 19, 1238- 1248.
[10] Keane, J. and Bresnihan, B. (2008) Tuberculosis Reactivation during Immune Suppressive Therapy in Rheumatic Diseases: Diagnostic and Therapeutic Strategies. Current Opinion in Rheumatology, 20, 443-449.
[11] Bieber, J. and Kavanaugh, A. (2004) Consideration of the Risk and Treatment of Tuberculosis in Patients Who Have Rheumatoid Arthritis and Receive Biologic Treatments. Rheumatic Disease Clinics of North America, 30, 257-270.
[12] Rychly, D.J. and Dipiro, J.T. (2005) Infections Associated with Tumor Necrosis Factor-Alpha Antagonists. Pharmacotherapy, 25, 1181-1192.
[13] Gutiérrez-Macías, A., Lizarralde-Palacios, E., Martínez-Odriozola, P. and Miguel-de la Villa, F. (2007) Tuberculous Peritonitis in a Patient with Rheumatoid Arthritis Treated with Adalimumab. Clinical Rheumatology, 26, 452-453.
[14] Scheinfeld, N. (2005) Adalimumab: A Review of Side Effects. Expert Opinion on Drug Safety, 4, 637-641.
[15] Mohan, A.K., Cote, T.R., Block, J.A., Manadan, A.M., Siegel, J.N. and Braun, M.M. (2004) Tuberculosis Following the Use of Etanercept, a Tumor Necrosis Factor Inhibitor. Clinical Infectious Diseases, 39, 295-299.
[16] Yoo, W.H. (2012) Multiple Organ Tuberculosis of Lung, Pleura, and Peritoneum in Ankylosing Spondylitis during Adalimumab Therapy. Rheumatology International, 32, 787-790.
[17] Dascalu, C., Valceanu, A., Brennessel, D. and Bandagi, S. (2013) New Therapies, Increased Risk for Old Infections— Abdominal Tuberculosis Mimicking Colon Cancer during Adalimumab Treatment for Rheumatoid Arthritis. Journal of Clinical Rheumatology, 19, 297-299.
[18] Chow, K.M., Chow, V.C. and Szeto, C.C. (2003) Indication for Peritoneal Biopsy in Tuberculous Peritonitis. The American Journal of Surgery, 185, 567-573.
[19] Marshall, J.B. (1993) Tuberculosis of the Gastrointestinal Tract and Peritoneum. American Journal of Gastroenterology, 88, 989-999.
[20] Chow, K.M., Chow, V.C., Hung, L.C., Wong, S.M. and Szeto, C.C. (2002) Tuberculous Peritonitis-Associated Mortality Is High among Patients Waiting for the Results of Mycobacterial Cultures of Ascitic Fluid Samples. Clinical Infectious Diseases, 35, 409-413.

comments powered by Disqus

Copyright © 2018 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.