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Table 3 Table summarizing cases published to date of mycobacterial disease in patients aged <18 years who were exposed to anti-TNFα agents

From: Tuberculosis in pediatric patients treated with anti-TNFα drugs: a cohort study

Pt

Ref

Primary disease

Anti-TNFα drug

Age/gender

Time on drug

Details on mycobacterial disease

Tuberculosis disease

1

[3]

JIA

Etanercept

NR

NR

Extrapulmonary

2

[3]

JIA

Etanercept

NR

NR

Extrapulmonary

3

[7]

Polyarticular JIA

Infliximab + MTX

NR

2y

Asymptomatic miliary TB (MTB PCR positive in sputum) with good response to 9-month standard treatment

4

[8]

Systemic JIA

Etanercept → infliximab + (previous extensive immunosuppressive therapy)

9y / female

NR

Subcutaneous cyst on the left wrist, after extensive microbiological studies, only MTB PCR in cyst fluid was positive. The child died after fulminant undiagnosed opportunistic pulmonary infection, 1 month after anti-TB drugs were implemented

5

[9]

Systemic JIA

Etanercept (previous CT and MTX)

9y / female

5wk

Ankle arthritis with positive MTB culture and normal chest X-ray; good response to 12-month standard treatment

6

[10]

SAPHO syndrome

Adalimumab (previous CT)

17y / female

3y

Meningeal and miliary TB presenting with septic shock; several PCR and cultures tested positive for MTB. Good response to therapy, but for neurologic sequelae. Adalimumab stopped 4 weeks earlier, suggesting immune reconstitution inflammatory syndrome

7

[11]

Polyarticular JIA

Infliximab (previous MTX)

13y / male

3 m

TB pleuritis (cultures negative) with good response to anti-TB therapy

8

[12]

Ulcerative colitis

Infliximab (previous CT and azathioprine)

17y / male

8 m

Miliary TB; the patient developed isoniazid-related hepatitis, but showed good response later on to an isoniazid-free regimen

9

[12]

Crohn’s disease

Infliximab

13y / female

2y

Disseminated TB disease with good response to 9-month standard therapy

Nontuberculous mycobacterial disease

10

[13]

Crohn’s disease

Infliximab → adalimumab (previous CT)

12y / female

9 m

Generalized lymphadenopathies due to culture-proven Mycobacterium avium complex infection; good response to ethambutol, clarithromycin and rifampin

11

[14]

Mother’s Crohn disease

Infliximab during gestation

3 m / male

36wk in utero

Bottle-fed. BCG vaccination at 3 m of age; disseminated BCGitis leading to death 6 weeks later

  1. BCG bacillus Calmette-Guérin, CT corticosteroids, MTB Mycobacterium tuberculosis, MTX methotrexate, NR not reported, PCR polymerase chain reaction, Pt patient, Ref reference, SAPHO synovitis acne pustulosis hyperostosis and osteitis