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TNF-α 억제제 사용 후 비장 결핵이 발생한 류마티스관절염 환자의 Rituximab 치료
김진수 ( Jin Su Kim ),최정란 ( Jung Ran Choi ),송정수 ( Jung Soo Song ),김경준 ( Kyung Joon Kim ),박윤수 ( Youn Su Park ),조준환 ( Jun Hwan Cho ),한민지 ( Min Jee Han ),최상태 ( Sang Tae Choi ) 대한류마티스학회 2013 대한류마티스학회지 Vol.20 No.2
저자들은 류마티스관절염에서 TNF-α 억제제 치료 후에 비장 결핵이 발생한 64세 여자 환자를 진단하고 치료하였으며, 결핵 치료 도중 악화된 류마티스관절염에 대하여 결핵의 악화 없이 rituximab으로 치료한 경험을 하였기에 이에 보고하는 바이다. One of the most important adverse effects of a tumor necrosis factor (TNF)-α inhibitor is the reactivation of tuberculosis. Most of them occur in the lung, but sometimes they can be found in other organs. Moreover, the proper management of active rheumatoid arthritis (RA) in patients with anti-TNF-α associated tuberculosis is still in debate. We present the case of a seropositive RA patient who showed good response with rituximab, an anti-CD20 monoclonal antibody, after developing splenic tuberuculosis, following treatment with TNF-α inhibitor. Confirming a diagnosis of splenic tuberculosis is difficult and can be delayed due to its nonspecific symptoms and rare occurrence. This case suggests that splenic tuberculosis should be doubted in RA patients treated with TNF-α inhibitor, and that rituximab may be considered as an alternative treatment option in RA patients with anti-TNF-α associated tuberculosis.