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2例患者在接受英夫利西单抗(IFX)治疗后并发肺结核。例1为23岁男性,因强直性脊柱炎给予口服甲氨蝶呤、来氟米特、洛索洛芬及静脉滴注IFX。IFX初始剂量200 mg,此后于第2、6、8周给予相同剂量。第4次输注IFX后2个月,患者出现发热,咳嗽、咯痰,抗结核分枝杆菌抗体(+),X线胸片示双肺弥漫性粟粒影,诊断为“粟粒性肺结核”。例2为54岁男性,因类风湿关节炎应用甲氨蝶呤、塞来昔布和IFX,IFX治疗方案同例1。患者于第2次IFX治疗后1个月出现轻微咳嗽、咯痰。胸部CT示双肺炎性改变。T细胞γ干扰素释放试验阳性。考虑为“肺结核可能”。2例患者在接受抗结核药物治疗后均好转。
Two patients developed pulmonary tuberculosis after receiving IFX. Example 1 A 23 year old man with oral methotrexate, leflunomide, loxoprofen and an intravenous infusion of IFX for ankylosing spondylitis. The initial dose of IFX was 200 mg and thereafter the same dose was administered at weeks 2, 6 and 8. Two months after the fourth infusion of IFX, the patient developed fever, cough, expectoration, anti-TB Mycobacterium antibody (+), and chest X-ray showed diffuse milky shadow of the lungs and was diagnosed as “miliary tuberculosis ”. Example 2 A 54 year old man with methotrexate, celecoxib, and IFX for rheumatoid arthritis, IFX treatment as in Example 1. Patients developed a slight cough and expectoration at 1 month after the second IFX treatment. Chest CT showed double lung inflammatory changes. T cell IFN-gamma release test positive. Considered for “tuberculosis possible.” Two patients improved after receiving anti-TB drug treatment.