Abstract：
OBJECTIVE: Tumor necrosis factor inhibitors (TNFi) are known to increase the risk of tuberculosis (TB) reactivation, though cases involving Mycobacterium bovis are rarely reported.
UNASSIGNED: We describe a case of disseminated TB with M. bovis in a 78-year-old woman with a negative Interferon-Gamma-Release Assay (IGRA), taking adalimumab due to rheumatoid polyarthritis, which resulted in a fatal outcome. The atypical clinical and histopathological features were initially interpreted as sarcoidosis. The case occurred in Switzerland, an officially bovine tuberculosis-free country. The whole genome sequence of the patient\'s cultured M. bovis isolate was identified as belonging to the animal lineage La1.2, the main genotype in continental Europe, but showed significant genetic distance from previously sequenced Swiss cattle strains. In a literature review, four cases of bovine tuberculosis reactivation under TNFi treatment were identified, with pulmonal, oral and intestinal manifestations. Similar to our patient, two cases presented a negative IGRA before TNFi initiation, which later converted to positive upon symptomatic presentation of M. bovis infection.
CONCLUSIONS: This case highlights the diagnostic challenges of TB in immunosuppressed patients, the limited sensitivity of IGRA, and the importance of considering TB reactivation even in regions declared free of bovine tuberculosis. Detailed patient histories, including potential exposure to unpasteurized dairy products, are essential for guiding preventive TB treatment before TNFi initiation.
UNASSIGNED: We describe a case of disseminated TB with M. bovis in a 78-year-old woman with a negative Interferon-Gamma-Release Assay (IGRA), taking adalimumab due to rheumatoid polyarthritis, which resulted in a fatal outcome. The atypical clinical and histopathological features were initially interpreted as sarcoidosis. The case occurred in Switzerland, an officially bovine tuberculosis-free country. The whole genome sequence of the patient\'s cultured M. bovis isolate was identified as belonging to the animal lineage La1.2, the main genotype in continental Europe, but showed significant genetic distance from previously sequenced Swiss cattle strains. In a literature review, four cases of bovine tuberculosis reactivation under TNFi treatment were identified, with pulmonal, oral and intestinal manifestations. Similar to our patient, two cases presented a negative IGRA before TNFi initiation, which later converted to positive upon symptomatic presentation of M. bovis infection.
CONCLUSIONS: This case highlights the diagnostic challenges of TB in immunosuppressed patients, the limited sensitivity of IGRA, and the importance of considering TB reactivation even in regions declared free of bovine tuberculosis. Detailed patient histories, including potential exposure to unpasteurized dairy products, are essential for guiding preventive TB treatment before TNFi initiation.
摘要：
目的：已知肿瘤坏死因子抑制剂（TNFi）会增加结核病（TB）再激活的风险，尽管涉及牛分枝杆菌的病例很少报道。
我们描述了一名78岁女性的牛分枝杆菌播散性结核病病例，干扰素-γ-释放试验（IGRA）为阴性，因类风湿多关节炎服用阿达木单抗，导致了致命的结果.非典型的临床和组织病理学特征最初被解释为结节病。案件发生在瑞士,一个没有牛结核病的国家.患者培养的牛分枝杆菌分离株的全基因组序列被鉴定为属于动物谱系La1.2，这是欧洲大陆的主要基因型，但显示出与先前测序的瑞士牛品系的显着遗传距离。在文献综述中，4例牛结核在TNFi治疗下再激活，肺门，口腔和肠道表现。和我们的病人一样,两例在TNFi启动前IGRA阴性，后来在牛分枝杆菌感染的症状表现后转化为阳性。
结论：这个案例突出了结核病在免疫抑制患者中的诊断挑战，IGRA的灵敏度有限，以及即使在宣布没有牛结核病的地区考虑结核病再激活的重要性。详细的病史，包括潜在暴露于未经巴氏消毒的乳制品，对于在开始TNFi之前指导预防性结核病治疗至关重要。
我们描述了一名78岁女性的牛分枝杆菌播散性结核病病例，干扰素-γ-释放试验（IGRA）为阴性，因类风湿多关节炎服用阿达木单抗，导致了致命的结果.非典型的临床和组织病理学特征最初被解释为结节病。案件发生在瑞士,一个没有牛结核病的国家.患者培养的牛分枝杆菌分离株的全基因组序列被鉴定为属于动物谱系La1.2，这是欧洲大陆的主要基因型，但显示出与先前测序的瑞士牛品系的显着遗传距离。在文献综述中，4例牛结核在TNFi治疗下再激活，肺门，口腔和肠道表现。和我们的病人一样,两例在TNFi启动前IGRA阴性，后来在牛分枝杆菌感染的症状表现后转化为阳性。
结论：这个案例突出了结核病在免疫抑制患者中的诊断挑战，IGRA的灵敏度有限，以及即使在宣布没有牛结核病的地区考虑结核病再激活的重要性。详细的病史，包括潜在暴露于未经巴氏消毒的乳制品，对于在开始TNFi之前指导预防性结核病治疗至关重要。
