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International Poster Journal of Dentistry and Oral Medicine
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Int Poster J Dent Oral Med 18 (2016), DGMKG     1. June 2016
Int Poster J Dent Oral Med 18 (2016), DGMKG  (01.06.2016)

Supplement, Poster 1005, Language: German/English


Unusual Case of a Reactivated Extrapulmonary Tuberculosis as a Result of Immunosuppression with Infliximab (Remicade) due to Psoriasis Geographica
Reactivation of Latent Tuberculosis under Immunosuppression with Infliximab
Holtmann, Henrik / Singh, DD / Kübler, NR / Sproll, C / Langie, R
Background: It is well known that under immunosuppressive therapy latent infectious diseases come cumulated to a reactivation as for example a tuberculosis.
Case report: We present a 49years old patient with a history of psoriasis geographica for 30 years and several immunosuppressive therapies. After changing the immunosppressive therapy to infliximab (Remicade) psoriatic symptoms went better while he developed within one month a fever resistant to antibiotics and a severe weight loss. In a nonresident performed CT and Mediastinoscoy showed an infiltrate in the left lung lobe and a mediastinal lymph node enlargement. Sample material gained by mediastinoscopy revealed. While medication with remicade was paused the named symptoms regressed spontaneously and further medication was performed with Fumaderm. One year after first appearance of the named symptoms they developed again. At that moment the patient recognized a supraclavicular swelling on the left side and again fever and weight loss. In a once more performed CT cervical melt-down lymph nodes were seen while the lung showed no pathologic result. A afterwards performed lymph node picking showed material that could be assigned to a typical tuberculosis by PCR for the first time while granulomas with central eosinophilic necrosis revealed once more no acid-proof rod cells. However a systemic tuberculostatic therapy could induce a full restitutio ad integrum for the patient.
Conclusion: Diseases that require an immunosuppression entail always the risk to develop malignant diseases, the activation of autoimmune disorders and the reactivation of latent infectious diseases which one should consider when starting a therapy with immunosuppressive substances.

Keywords: extrapulmonary tuberculosis, Infliximab, Psoriasis geographica

Conference/Exhibition:
66. Kongress und Praxisführungsseminar der Deutschen Gesellschaft für Mund-, Kiefer- und Gesichtschirurgie
01.-04. June 2016
Hamburg, Germany