摘要
感染在有 anti-TNF-alpha 的治疗期间是主要不利效果。当时任何细菌的感染的排除并且屏蔽因为肺结核在与 anti-TNF-alpha-antibodies 开始治疗前是强制的，没有指南是否屏蔽为或怎么处理象肝炎 B 那样的长期的病毒的感染。在这份病案报告，我们与 Crohn 的疾病描述了一个病人发展了由于一个未被认出的 HBs 抗原带菌状态在 infliximab 的第四注入以后代替暴发性的肝炎 B。在 lamivudine 治疗被开始以后，他完全恢复了，但是如果与 lamivudine 为 HBV 和抢先式的治疗屏蔽将在 infliximab 以前被开始，这个严重不利事件能被阻止了。我们强烈因此争论赞成在与 infliximab 考虑治疗前包括病毒的感染为传染病屏蔽建议扩大。
Infections are a major adverse effect during the treatment with anti-TNF-α. While exclusion of any bacterial infection and screening for tuberculosis are mandatory before initiating a therapy with anti-TNF- α-antibodies, there are no guidelines whether to screen for or how to deal with chronic viral infections such as hepatitis B. In this case report, we have described a patient with Crohn＇s disease who developed subfulminant hepatitis B after the fourth infusion of infliximab due to an unrecognized HBs-antigen carrier state. He recovered completely after lamivudine therapy was started, but this severe adverse event could have been prevented if screening for HBV and pre-emptive therapy with lamivudine would have been started prior to infliximab. We therefore strongly argue in favor of extended screening recommendations for infectious diseases including viral infections before considering a therapy with infliximab.
基金
Supported by the"Verein zur F rderung der Wissenschaft in Gastroenterologie und Hepatologie"
