Ustekinumab

Reactions 1445 - 30 Mar 2013 S Ustekinumab Latent tuberculosis reactivation in an elderly patient: case report A 65-year-old man developed latent tuberculosis reactivation while receiving ustekinumab for psoriasis. The man, who had a 15-year history of psoriasis, was enrolled in the randomised PEARL trial. A baseline tuberculosis screening was negative, but a screening chest x-ray revealed a fibronodular lesion on the right upper lung, which had first been observed 5 years prior to study enrolment. He had no signs or symptoms indicative of active tuberculosis and did not receive any tuberculosis prophylaxis during the trial. After being randomised to receive placebo at weeks 0 and 4, he was crossed over to ustekinumab 45mg injection at weeks 12 and 16. Sputum samples for acid-fast bacilli and Mycobacterium culture were negative after 8 weeks. Four weeks after the second ustekinumab injection, a follow-up chest x-ray demonstrated enlargement of the chest lesion relative to baseline. A CT scan confirmed a 2.2cm nodule with satelite fibrocalcified lesions, and he was hospitalised with suspected lung cancer. Repeat tests for tuberculosis were positive, resulting in a diagnosis of latent tuberculosis infection reactivation. The man was started on rifampicin, pyrazinamide, isoniazid and ethambutol. He was discharged after 1 week, and remained asymptomatic through 9 months of combination antituberculosis treatment. Repeat CT scans showed the lesion to be decreasing, and no detectable lesion was seen 10 months after diagnosis. Author comment: "Although ustekinumab did not appear to impair the patient’s response to antituberculosis treatment, it was a probable factor in this [latent tuberculosis infection] reactivation, considering the short interval (approximately 3 months after the first dose of ustekinumab) during which there was seroconversion by [tuberculosis test], in the absence of any known source of exposure". Tsai T-F, et al. A case of latent tuberculosis reactivation in a patient treated with ustekinumab without concomitant isoniazid chemoprophylaxis in the PEARL trial. British Journal of Dermatology 168: 444-446, No. 2, Feb 2013. Available from: URL: http://dx.doi.org/10.1111/j.1365-2133.2012.11162.x - Taiwan 803085067 1 Reactions 30 Mar 2013 No. 1445 0114-9954/10/1445-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

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Reactions 1445 - 30 Mar 2013

SUstekinumab

Latent tuberculosis reactivation in an elderlypatient: case report

A 65-year-old man developed latent tuberculosisreactivation while receiving ustekinumab for psoriasis.

The man, who had a 15-year history of psoriasis, wasenrolled in the randomised PEARL trial. A baseline tuberculosisscreening was negative, but a screening chest x-ray revealed afibronodular lesion on the right upper lung, which had firstbeen observed 5 years prior to study enrolment. He had nosigns or symptoms indicative of active tuberculosis and did notreceive any tuberculosis prophylaxis during the trial. Afterbeing randomised to receive placebo at weeks 0 and 4, he wascrossed over to ustekinumab 45mg injection at weeks 12 and16. Sputum samples for acid-fast bacilli and Mycobacteriumculture were negative after 8 weeks. Four weeks after thesecond ustekinumab injection, a follow-up chest x-raydemonstrated enlargement of the chest lesion relative tobaseline. A CT scan confirmed a 2.2cm nodule with satelitefibrocalcified lesions, and he was hospitalised with suspectedlung cancer. Repeat tests for tuberculosis were positive,resulting in a diagnosis of latent tuberculosis infectionreactivation.

The man was started on rifampicin, pyrazinamide, isoniazidand ethambutol. He was discharged after 1 week, andremained asymptomatic through 9 months of combinationantituberculosis treatment. Repeat CT scans showed the lesionto be decreasing, and no detectable lesion was seen 10 monthsafter diagnosis.

Author comment: "Although ustekinumab did not appearto impair the patient’s response to antituberculosis treatment,it was a probable factor in this [latent tuberculosis infection]reactivation, considering the short interval (approximately3 months after the first dose of ustekinumab) during whichthere was seroconversion by [tuberculosis test], in theabsence of any known source of exposure".Tsai T-F, et al. A case of latent tuberculosis reactivation in a patient treated withustekinumab without concomitant isoniazid chemoprophylaxis in the PEARL trial.British Journal of Dermatology 168: 444-446, No. 2, Feb 2013. Available from:URL: http://dx.doi.org/10.1111/j.1365-2133.2012.11162.x - Taiwan 803085067