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Case Reports: Findings that shed new light on the possible pathogenesis of a disease
Laryngeal tuberculosis in patients treated with adalimumab: a casual or causal connection?
  1. Giulia Molinari1,2,
  2. Alessandro Rosti1,2,
  3. Livio Presutti1,2 and
  4. Guido Marzocchi3
  1. 1Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
  2. 2Otorhinolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
  3. 3Emergency Radiology, Azienda Ospedaliero-Universitaria di Bologna IRCCS, Bologna, Italy
  1. Correspondence to Dr Guido Marzocchi; guido.marzocchi{at}gmail.com

Abstract

This article presents two consecutive cases of laryngeal tuberculosis in patients treated with a specific anti-tumour necrosis factor-alpha (adalimumab), with a focus on their diagnostic process and therapeutic management. Both patients presented with aspecific chronic laryngeal symptoms that had been worsening for a few months in one case and for almost 1 year in the other one. They were both studied with fibreoptic laryngoscopy and contrast-enhanced CT and MRI scans. In both cases, the laryngeal biopsy proved negative to Ziehl-Neelsen test, while positive to Koch’s bacillus sensitive to rifampicin at PCR test. Both patients completely responded to standard antitubercular antibiotic therapy with rifampicin, isoniazid, pyrazinamide and etambutol protocol.

In the differential diagnosis of such patients, laryngeal tuberculosis should be considered due to the reasonable linkage between the immunosuppressant therapy with adalimumab and the tuberculosis infection/reactivation.

  • Drugs and medicines
  • Ear, nose and throat
  • Infections
  • Ear, nose and throat/otolaryngology

https://doi.org/10.1136/bcr-2023-254742

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    Footnotes

    • Contributors GMolinari—draft correction and approval. AR—writing of the first draft. LP—supervision. GMarzocchi—final approval and collection of radiological data.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.