Disseminated tuberculosis and heart failure in a patient receiving infliximab for psoriasis

�al��kan, Ercan; Do�an, Deniz; Ko�, Erol; A��kg�z, G�rol; G�ko�lan, Yal��n; �ekli, Yavuz; Akar, Ahmet

Disseminated tuberculosis and heart failure in a patient receiving infliximab for psoriasis [Turkderm-Turk Arch Dermatol Venereol]

Turkderm-Turk Arch Dermatol Venereol. 2014; 48(2): 121-124 | DOI: 10.4274/turkderm.48.s32

Disseminated tuberculosis and heart failure in a patient receiving infliximab for psoriasis

Ercan �al��kan¹, Deniz Do�an², Erol Ko�¹, G�rol A��kg�z¹, Yal��n G�ko�lan³, Yavuz �ekli⁴, Ahmet Akar¹
¹Gulhane Military Medical Faculty, Department of Dermatology, Ankara, Turkey
²Gulhane Military Medical Faculty, Department of Pulmonary Medicine, Ankara, Turkey
³Gulhane Military Medical Faculty, Department of Cardiology, Ankara, Turkey
⁴Gulhane Military Medical Faculty, Department of Infectious Diseases, Ankara, Turkey

A 20-year-old male was admitted to our department with the complaint of pustular psoriasis. Initial conventional therapies including cyclosporin and methotrexate were discontinued due to the onset of hypertension and elevated liver enzymes. Consequently, infliximab therapy was started after one month of prophylaxis for latent tuberculosis infection. Here, we report a case of disseminated tuberculosis and heart failure associated with infliximab therapy. After the cessation of infliximab and starting therapy for both heart failure and tuberculosis, the patient improved significantly. Tuberculosis reactivation and heart failure are known side effects associated with biologic agents, but, as far as we know, there are no published reports of both condition in the same patient in the literature.

Keywords: Psoriasis, infliximab, tuberculosis, heart failure, biologic agent, adverse effect

Psoriasis nedeniyle infliksimab kullanmakta olan hastada geli�en dissemine t�berk�loz ve kalp yetmezli�i

Ercan �al��kan¹, Deniz Do�an², Erol Ko�¹, G�rol A��kg�z¹, Yal��n G�ko�lan³, Yavuz �ekli⁴, Ahmet Akar¹
¹Gata Askeri T�p Akademisi, Deri ve Z�hrevi Hastal�klar, Ankara, T�rkiye
²Gata Askeri T�p Akademisi, G��s Hastal�klar�, Ankara, T�rkiye
³Gata Askeri T�p Akademisi, Kardiyoloji, Ankara, T�rkiye
⁴Gata Askeri T�p Akademisi, �nfeksiyon Hastal�klar� Anabilim Dal�, Ankara, T�rkiye

Yirmi ya��nda erkek hasta klini�imize p�st�ler psoriasis tablosu ile m�racaat etti. Siklosporin ve metotreksat� i�eren ba�lang��taki konvansiyonel tedaviler hipertansiyon ve karaci�er enzimlerinde y�kseklik nedeniyle kesildi. Sonras�nda, 1 ayl�k latent t�berk�loz infeksiyonu profilaksisini takiben infliksimab tedavisi ba�land�. Burada, infliksimab tedavisi ile ili�kili bir dissemine t�berk�loz ve kalp yetmezli�i olgusu sunuyoruz. �nfliksimab tedavisi kesildikten ve kalp yetmezli�i ile t�berk�loza y�nelik tedaviler ba�land�ktan sonra hasta belirgin �ekilde iyile�ti. T�berk�loz reaktivasyonu ve kalp yetmezli�i biyolojik ajanlara ba�l�, bilinen yan etkileridir, ancak bildi�imiz kadar�yla literat�rde her iki tablonun ayn� bireyde geli�imi bildirilmemi�tir.

Anahtar Kelimeler: Psoriasis, infliksimab, t�berk�loz, kalp yetmezli�i, biyolojik ajan, advers etki

Ercan �al��kan, Deniz Do�an, Erol Ko�, G�rol A��kg�z, Yal��n G�ko�lan, Yavuz �ekli, Ahmet Akar. Disseminated tuberculosis and heart failure in a patient receiving infliximab for psoriasis. Turkderm-Turk Arch Dermatol Venereol. 2014; 48(2): 121-124

Corresponding Author: Erol Ko�, T�rkiye

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