Fatal Unusual Miliary Tuberculosis in which a Patient Developed Acute Respiratory Distress Syndrome Induced by Infliximab: An Autopsy Case Report

• Published in: Internal Medicine Vol. 56; no. 9; pp. 1079 - 1083
• Main Authors: Miyoshi, Shion, Takasaki, Jin, Mine, Sohtaro, Kono, Masanori, Igari, Toru, Takeda, Yuichiro, Hojo, Masayuki, Sugiyama, Haruhito
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 01.01.2017; Japan Science and Technology Agency
• Subjects: acute respiratory distress syndrome; Aged; Antirheumatic Agents - adverse effects; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - drug therapy; Autopsy; Case Report; Fatal Outcome; Female; Humans; immune reconstitution inflammatory syndrome; Infliximab; Infliximab - adverse effects; Infliximab - therapeutic use; Internal medicine; Lung - pathology; Lung nodules; Monoclonal antibodies; Respiratory distress syndrome; Respiratory Distress Syndrome, Adult - etiology; Respiratory Distress Syndrome, Adult - mortality; Respiratory therapy; rheumatoid arthritis; Tuberculosis; Tuberculosis, Miliary - drug therapy; Tuberculosis, Miliary - mortality; Tuberculosis, Miliary - physiopathology; Tumor necrosis factor-α; acute respiratory distress syndrome; immune reconstitution inflammatory syndrome; autopsy; rheumatoid arthritis; infliximab; tuberculosis
• ISSN: 0918-2918; 1349-7235; 1349-7235
• DOI: 10.2169/internalmedicine.56.7944

Anti-tumor necrosis factor α (anti-TNFα) agents increase the risk of tuberculosis (TB), but cases are rarely fatal. This report concerns a patient who was undergoing treatment with infliximab and presented with acute respiratory distress syndrome due to miliary TB without a miliary shadow. The findings of a pathological autopsy revealed innumerable granulomas in the organs, and the miliary nodules in the lung consisted of more unstructured granulomas. Anti-TNFα agents are unusual in the presentation of TB. It is important, particularly for patients receiving anti-TNFα agents, to constantly consider the possibility of TB and to prepare for appropriate management.