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Case Reports
. 2016 Mar 15;62(6):770-773.
doi: 10.1093/cid/civ995. Epub 2015 Dec 8.

Severe Paradoxical Reaction During Treatment of Disseminated Tuberculosis in a Patient With Neutralizing Anti-IFNγ Autoantibodies

Yingda L Xie  1 , Lindsey B Rosen  1 , Irini Sereti  2 , Daniel L Barber  3 , Ray Y Chen  1 , Denise C Hsu  2 , S Sonia Qasba  4 , Christa S Zerbe  1 , Steven M Holland  1 , Sarah K Browne  1
Affiliations
Case Reports

Severe Paradoxical Reaction During Treatment of Disseminated Tuberculosis in a Patient With Neutralizing Anti-IFNγ Autoantibodies

Yingda L Xie et al. Clin Infect Dis. .

Abstract

Interferon-gamma (IFNγ) neutralizing autoantibodies are associated with disseminated nontuberculous mycobacterial infections. We report a previously healthy Thai woman with disseminated tuberculosis and high-titer IFNγ-neutralizing autoantibodies, who developed a severe inflammatory reaction during anti-tuberculosis treatment. IFNγ contributes to host control of tuberculosis but appears inessential for tuberculosis paradoxical reactions.

Keywords: IRIS; autoantibodies; disseminated tuberculosis; interferon-gamma; paradoxical reaction.

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Figures

Figure 1.
Figure 1.
A, Computed tomography series. Top left: Air-filled, thin-walled left upper lobe cavity. Top right: Bilateral cervical soft tissue densities contiguous with the subcutaneous surface. Bottom left: Numerous, predominantly sclerotic, osseous lesions within the lumbar spine and right iliac bone. Bottom right: Soft tissue abscesses in left axilla. B, Multiplex screening of plasmas from patient and 8 normal control plasmas for anticytokine autoantibodies. C, Evaluation of anti-interferon (IFN) autoantibody immunoglobulin G (IgG) subclass in patient plasma. D, Normal or patient peripheral blood mononuclear cells (PBMC) were incubated in the presence of normal or patient plasma and left unstimulated or stimulated for 15 minutes with IFNγ. Cells fixed and stained for intracellular phosphorylated STAT-1 were measured by flow cytometry, gating on CD14+ monocytes.
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Comment in

References

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