Case of rheumatoid arthritis presenting with pulmonary tuberculosis]

A 72-year-old man who had been suffering from rheumatoid arthritis for 25 years developed pulmonary tuberculosis after treatment with infliximab. He had been receiving this treatment since December 2003. Forty-six days later, a fever developed and the patient was hospitalized on February 3, 2004. Chest radiography and chest CT showed an infiltrative shadow with cavity formation. Mycobacterium tuberculosis was detected in the sputum. Infliximab is a monoclonal antibody toward tumor necrosis factor alpha (TNFalpha). It has been reported that infliximab increases the risk of tuberculosis in patients with rheumatoid arthritis in Europe and North America. This is the first case of pulmonary tuberculosis in a patient treated with infliximab in Japan.