ReviewEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology2023
The use of TNF-α antagonists in tuberculosis to control severe paradoxical reaction or immune reconstitution inflammatory syndrome: a case series and literature review.
Review in European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
20 citing papers in PubMed, 29 citations in OpenAlex.
- Rapid recovery from near-fatal immune reconstitution inflammatory syndrome and acute respiratory distress syndrome following neutropenic recovery by cytokine adsorption.BMC pulmonary medicine · 2026Article
- A case of miliary tuberculosis after prophylactic therapy for latent tuberculosis.Clinical journal of gastroenterology · 2026Article
- Prolonged Paradoxical TB-IRIS: 2 Case Reports and a Review of the Literature.Open forum infectious diseases · 2026Article
- A Case of Uncommon Tuberculosis Infection Involving the Sternoclavicular Joint.The American journal of case reports · 2026Article
- Miliary Tuberculosis: A Comprehensive Review of Epidemiology, Clinical Manifestations, Diagnosis, Treatment, and Complications.Infection and drug resistance · 2026Review
- Revisiting visceral leishmaniasis in immunocompromised patients: Ongoing gaps and advances in diagnostics, therapies, and preventive measures.Current research in parasitology & vector-borne diseases · 2026Review
- Disseminated PrimaryCase reports in infectious diseases · 2026Article
- Thalidomide as an Adjunctive Therapy for HIV-Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome: A Case Series.Open forum infectious diseases · 2025Article
- Advances in host-directed therapy for tuberculosis and HIV coinfection: enhancing immune responses.Trends in microbiology · 2025Review
- Diagnostic dilemma of a new endobronchial lesion in a patient on anti-tuberculosis regimen: unveiling tuberculosis immune reconstitution inflammatory syndrome.BMC infectious diseases · 2025Article
- Tuberculosis disease among people with HIV: therapeutic advances.The lancet. HIV · 2025Review
- Immune reconstitution inflammatory syndrome (IRIS): Case series and review of the literature.Respiratory medicine case reports · 2025Article
- Post-tuberculosis treatment paradoxical reactions.Infection · 2024Review
- Tuberculosis and Immune Reconstitution Inflammatory Syndrome in Patients With Inflammatory Bowel Disease and Anti-TNFα Treatment: Insights From a French Multicenter Study and Systematic Literature Review With Emphasis on Paradoxical Anti-TNFα Resumption.Open forum infectious diseases · 2024Article
- Comment on: Clinical Characteristics, Diagnosis, and Treatments for COVID-19.Current medical science · 2024Article
- Successful rescue TNF-α blocking forHeliyon · 2024Article
- Perplexing paradoxical reactions: navigating the complexity of protracted tuberculosis meningitis-a case report.Frontiers in immunology · 2024Article
- Case Report and Literature Review of "Treatment Failure" of Aspergillus Infection Secondary to Influenza a Virus.Journal of inflammation research · 2024Article
- Spectacular Improvement of Paradoxical Reaction in Tuberculosis after Tumor Necrosis Factor-Alpha Antagonist Therapy.Cureus · 2023Article
- Therapeutic advances in neuroinfectious diseases.Therapeutic advances in infectious diseaseReview
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Paradoxical reaction (PR) and immune reconstitution inflammatory syndrome (IRIS) are common complications of tuberculosis treatment. Corticosteroids are first-line treatment for severe PR or IRIS, particularly neurological. We report four cases of severe PR or IRIS during tuberculosis treatment who required TNF-α antagonists, and identified 20 additional cases through literature review. They were 14 women and 10 men, with a median age of 36 years (interquartile range, 28-52). Twelve were immunocompromised before tuberculosis: untreated HIV infection (n=6), or immunosuppressive treatment (TNF-α antagonists, n=5; tacrolimus, n=1). Tuberculosis was mostly neuromeningeal (n=15), pulmonary (n=10), lymph node (n=6), and miliary (n=6), multi-susceptible in 23 cases. PR or IRIS started after a median time of 6 weeks (IQR, 4-9) following anti-tuberculosis treatment start, and consisted primarily of tuberculomas (n=11), cerebral vasculitis (n=8), and lymphadenitis (n=6). First-line treatment of PR or IRIS was high-dose corticosteroids in 23 cases. TNF-α antagonists were used as salvage treatment in all cases, with infliximab (n=17), thalidomide (n=6), and adalimumab (n=3). All patients improved, but 6 had neurological sequelae, and 4 had TNF-α antagonist-related severe adverse events. TNF-α antagonists are safe and effective as salvage or corticosteroid-sparing therapeutic for severe PR or IRIS during tuberculosis treatment.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.