La tuberculosis en la era del tratamiento con fármacos inhibidores del factor de necrosis tumoral alfa: ¿por qué persiste el riesgo?

John-Leonardo Torres-Castiblanco, Jorge Alberto Carrillo, Daniel Hincapié-Urrego, Adriana Rojas-Villarraga, .

Palabras clave: Mycobacterium tuberculosis, tuberculosis, diagnóstico, artritis reumatoidea, factor de riesgo, factor de necrosis tumoral alfa, terapia biológica, infliximab, Colombia

Resumen

La artritis reumatoidea es una enfermedad crónica de carácter autoinmunitario caracterizada principalmente por el compromiso inflamatorio de las articulaciones cartilaginosas. Se han desarrollado múltiples tratamientos farmacológicos para controlar el avance de la artritis reumatoidea, entre ellos, los fármacos antirreumáticos modificadores de la enfermedad, además de nuevos esquemas terapéuticos con inhibidores del factor de necrosis tumoral alfa, con resultados clínicos satisfactorios. Sin embargo, el uso de tales medicamentos no resulta inocuo, ya que se los ha asociado con diversos efectos
secundarios, especialmente, infecciones como la tuberculosis, lo cual exige la aplicación de pruebas de tamización antes de utilizarlos.
Se reporta el caso de una paciente de 58 años de edad con artritis reumatoidea de seis años de evolución, que después de recibir tratamiento con uno de estos fármacos, el infliximab, desarrolló tuberculosis diseminada, cuyo diagnóstico se confirmó mediante radiología e histopatología. No se emplearon pruebas de detección de la tuberculosis latente antes de prescribirle el infliximab.
Las pruebas de tamización para tuberculosis deben emplearse de forma rutinaria, con el fin de detectar aquellos pacientes con tuberculosis latente, ya que es la única manera de determinar si se requiere profilaxis antituberculosa antes de administrar dichos fármacos, hecho que marca la diferencia cuando se busca disminuir la incidencia de tuberculosis y la consecuente morbimortalidad.

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  • John-Leonardo Torres-Castiblanco Centro de Estudio de Enfermedades Autoinmunes (CREA), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, D.C., Colombia
  • Jorge Alberto Carrillo Departamento de Radiología, Hospital Universitario Mayor-Méderi, Bogotá, D.C., Colombia
  • Daniel Hincapié-Urrego Centro de Estudio de Enfermedades Autoinmunes (CREA), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, D.C., Colombia
  • Adriana Rojas-Villarraga Centro de Estudio de Enfermedades Autoinmunes (CREA), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, D.C., Colombia

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Cómo citar
Torres-Castiblanco, J.-L., Carrillo, J. A., Hincapié-Urrego, D., & Rojas-Villarraga, A. (2018). La tuberculosis en la era del tratamiento con fármacos inhibidores del factor de necrosis tumoral alfa: ¿por qué persiste el riesgo?. Biomédica, 38(1), 17-26. https://doi.org/10.7705/biomedica.v38i0.3458
Publicado
2018-03-15
Sección
Presentación de caso