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Korean J Gastroenterol  <  Volume 74(3); 2019 <  Articles

Korean J Gastroenterol 2019; 74(3): 168-174  https://doi.org/10.4166/kjg.2019.74.3.168
Multidrug-resistant Disseminated Tuberculosis Related to Infliximab in a Patient with Ulcerative Colitis and Negative Evaluation for Latent Tuberculosis
Yu Kyung Jun1, Jaeyoung Chun1 ,2, Eun Ae Kang1, Hyun Jung Lee1, Jong Pil Im1 and Joo Sung Kim1
Department of Internal Medicine, Seoul National University College of Medicine1; Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine2, Seoul, Korea
Correspondence to: Jaeyoung Chun, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 20 Eonju-ro 63-gil, Gangnam-gu, Seoul 06229, Korea. Tel: +82-2-2019-3310, Fax: +82-2-3463-3882, E-mail: chunjmd@yuhs.ac, ORCID: https://orcid.org/0000-0002-4212-0380
Received: May 27, 2019; Revised: July 6, 2019; Accepted: July 29, 2019; Published online: September 25, 2019.
© The Korean Journal of Gastroenterology. All rights reserved.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Anti-tumor necrosis factor (anti-TNF) is an effective biological agent for the treatment of moderate-to-severe active ulcerative colitis (UC) refractory to conventional therapy. On the other hand, anti-TNF therapy is strongly associated with a potential risk of tuberculosis (TB). Active TB is a critical complication that makes it difficult to treat patients who require anti-TNF for the treatment of UC refractory to conventional therapy. Based on the clinical guidelines, patients with inflammatory bowel disease (IBD) are strongly recommended to screen for latent TB before anti-TNF administration. Considering the possibility of active or reactivated TB related to anti-TNF therapy, all patients with IBD should be monitored closely for TB during anti-TNF therapy, irrespective of the screening results for latent TB. In particular, the risk of anti-TNF-related multidrug-resistant TB (MDR-TB) in patients with IBD has not been elucidated. This paper reports the first case of disseminated MDR-TB that developed in a UC patient receiving infliximab despite the negative evaluation for latent TB screening.
Keywords: Inflammatory bowel diseases; Infliximab; Tuberculosis, multidrug-resistant; Colitis, ulcerative


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