Tuberculosis ocular en el contexto de enfermedad diseminada

espanolVaron de 62 anos que recibio adalimumab como tratamiento para la colitis ulcerosa. Meses mas tarde, desarrollo astenia progresiva, febricula y malestar que le indujeron a asistir en varias ocasiones al servicio de Urgencias del Hospital Universitario de Canarias. En la ultima visita se establecio el diagnostico de tuberculosis diseminada. La diseminacion de la enfermedad afecto al cerebro, bazo, higado, ganglios linfaticos y la estructura coroidal del ojo derecho. El paciente recibio tratamiento con Isoniazida, Rifampicina, Etambutol, Pirazinamida y Levofloxacino, con mejoria del estado general y reduccion de la diseminacion miliar de forma progresiva. Sin embargo, se desarrollaron grandes adenopatias y aparecieron multiples cavitaciones en bazo; ambas requirieron extirpacion quirurgica. Posiblemente estas complicaciones reflejan un sindrome de reconstitucion inmune EnglishA Sixty two-year-old male patient received adalimumab as a treatment for ulcerative colitis. A few months later he developed progressive astenia, low grade fever and malaise that prompted him to attend the emergency unit of our hospital several times. At the last visit the diagnosis of disseminated tuberculosis was established. Dissemination of the disease affected brain, spleen, liver, lymph nodes and coroidal structures of the right eye. The patient received treatment with Isoniazid, Rifampin, Ethambutol, Pyrazinamide and Levofloxacin, with improvement of the general status and progressive reduction of the miliary dissemination. However, largest adenopathies developed and multiple cavitations appeared in the spleen, both requiring surgical excision. Possibly these complications may reflect an immune reconstitution syndrome.