Paradoxical exacerbation of tuberculosis after TNFα antagonist discontinuation: Beware of immune reconstitution inflammatory syndrome

Paradoxical worsening of tuberculosis associated with immune reconstitution during antiretroviral therapy in patients with HIV infection is known as the immune reconstitution inflammatory syndrome (IRIS). Here, we report a case of paradoxical worsening of IFN-alpha induced tuberculosis in a patient experiencing reconstitution of pathogen-specific immune responses after discontinuing TNF alpha antagonist therapy. This case serves to alert clinicians that complications such as tuberculosis may worsen after TNF alpha antagonist discontinuation. This situation may paradoxically require readministration of the immunosuppressive drug in some patients. (C) 2011 Societe francaise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.