Zusammenfassung
Ein 34-jähriger HIV-positiver Patient mit Colitis ulcerosa unter Anti- Tumor-Nekrose-Faktor-(TNF-)α-Therapie mit Infliximab wurde bei zunehmender Verschlechterung des Allgemeinzustands mit intermittierend febrilen Temperaturen, progredienter Lymphopenie, Anämie, Thrombopenie und Neutropenie in die Klinik der Autoren überwiesen. Trotz negativer Screeninguntersuchungen vor Beginn und während der Therapie mit Infliximab wurde schließlich eine Miliartuberkulose diagnostiziert und eine tuberkulostatische Therapie begonnen. Im Verlauf kam es bei dem Patienten zu einer progredienten Verschlechterung des klinischen Zustandsbilds mit Entwicklung einer schweren exsudativ-nekrotisierenden Form der Pankreatitis. Im weiteren Verlauf verstarb der Patient unter zunehmender respiratorischer Erschöpfung nach Entwicklung von progredienten pulmonalen Infiltraten und Pleuraergüssen.
Abstract
A 34-year-old HIV-positive patient with ulcerative colitis was transferred to the authors’ hospital because of progressive worsening of his general condition with intermittent fever, increasing lymphopenia, anemia, thrombopenia and neutropenia under anti-tumor necrosis factor-(TNF-)α therapy with infliximab. In spite of negative screening tests before initiation of infliximab therapy and intermittent tests during treatment, miliary tuberculosis was finally diagnosed and a tuberculostatic therapy was started. The patient’s clinical condition worsened due to the development of a serious exudative necrotizing pancreatitis which was likely to be caused by the tuberculostatic treatment. Due to severe pulmonary infiltrates and pleural effusions with respiratory failure the patient finally passed away.
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Zeitz, J., Huber, M. & Rogler, G. Schwerer Verlauf einer Miliartuberkulose bei einem 34-jährigen Patienten mit Colitis ulcerosa und HIV-Infektion unter einer TNF-α-Antikörper-Therapie. Med Klin 105, 314–318 (2010). https://doi.org/10.1007/s00063-010-1046-2
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DOI: https://doi.org/10.1007/s00063-010-1046-2