Serious course of a miliary tuberculosis in a 34-year-old patient with ulcerative colitis and HIV infection under concomitant therapy with infliximab

摘要

A 34-year-old HIV-positive patient with ulcerative colitis was transferred to the authors' hospital because of progressive worsening of his general condition with intermittent fever, increasing lymphopenia, anemia, thrombopenia and neutropenia under anti-tumor necrosis factor-(TNF-)alpha therapy with infliximab. In spite of negative screening tests before initiation of infliximab therapy and intermittent tests during treatment, miliary tuberculosis was finally diagnosed and a tuberculostatic therapy was started. The patient's clinical condition worsened due to the development of a serious exudative necrotizing pancreatitis which was likely to be caused by the tuberculostatic treatment. Due to severe pulmonary infiltrates and pleural effusions with respiratory failure the patient finally passed away.