Case Report and literature review: complications of the association between rheumatoid arthritis and tuberculosis.
5 affiliations
- 1Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
- 2Marius Nasta Institute of Pneumophtisiology, Bucharest, Romania.
- 3Titu Maiorescu University of Medicine and Pharmacy, Bucharest, Romania.
- 4Prof. Dr. Agrippa Ionescu Emergency Clinical Hospital, Bucharest, Romania.
- 5Dr. Ion Stoia Clinical Center of Rheumatic Diseases, Bucharest, Romania.
Abstract
Background
Pulmonary tuberculosis is one of the major public health issues globally. According to the World Health Organization, it is among the top 10 causes of death caused by a single pathogen. In Romania, its reported incidence rate in 2024 was approximately 60 per 100,000 people, making it the country with the highest incidence in Europe. Rheumatoid arthritis (RA) is a systemic chronic autoimmune inflammatory disease characterized by the destruction of the small joints along with symmetrical distribution and multiorgan involvement. Pulmonary manifestations are more common in males with positive serology and can involve the lungs, airways, or pleura. Short-term corticotherapy may be initiated in patients with severe symptoms, and biological therapy (anti-TNF alpha drugs) may be used in those with inefficiency of disease-modifying antirheumatic drugs, with an increased risk for disseminated forms of tuberculosis in those with latent infection.Case description
We present the case of a 38-year-old male patient with a 5-year history of seropositive RA who was treated with methotrexate and methylprednisolone, without any prior investigations for latent tuberculosis infection or any chest radiography performed, and was admitted with severe respiratory failure. The results of thoracic computed tomography showed bilateral pneumothorax and pneumomediastinum, with pulmonary lesions suggestive of a diagnosis of tuberculosis, which was confirmed by bacteriological testing of samples.Conclusion
The coexistence of two severe diseases-one requiring immunosuppressive treatment and the other one favored by immunosuppression-in a country with a high prevalence of tuberculosis infection and in the absence of latent tuberculosis infection screening or periodic pulmonological assessment can lead to severe, life-threatening complications that require complex, multidisciplinary, long-term, and expensive management.
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- Lung Ultrasound in Rheumatoid Arthritis–Associated Interstitial Lung Disease: Association with Radiological Patterns, Lung Function Tests, and Disease Activity—A Single-Center Retrospective Cross-Sectional Study
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BibTeX
@article{cristea2026case,
title = {{Case Report and literature review: complications of the association between rheumatoid arthritis and tuberculosis.}},
author = {Alexandra-Maria Cristea and Dragos-Cosmin Zaharia and Oana Andreea Parliteanu and Ioan Berila and Alexandra Minca and Dragos Minca and Stefan Dumitrache-Rujinski and Ionela Alina Croitoru and Ana Maria Zaharie and Adelina Afetelor and Irina Ruxandra Strambu},
journal = {Frontiers in medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1971306},
url = {https://europepmc.org/article/MED/42908796},
note = {CC BY},
}
RIS
TY - JOUR
TI - Case Report and literature review: complications of the association between rheumatoid arthritis and tuberculosis.
AU - Alexandra-Maria Cristea
AU - Dragos-Cosmin Zaharia
AU - Oana Andreea Parliteanu
AU - Ioan Berila
AU - Alexandra Minca
AU - Dragos Minca
AU - Stefan Dumitrache-Rujinski
AU - Ionela Alina Croitoru
AU - Ana Maria Zaharie
AU - Adelina Afetelor
AU - Irina Ruxandra Strambu
PY - 2026
DA - 2026/10/07
JO - Frontiers in medicine
DO - 10.3389/fmed.2026.1971306
UR - https://europepmc.org/article/MED/42908796
AB - Background Pulmonary tuberculosis is one of the major public health issues globally. According to the World Health Organization, it is among the top 10 causes of death caused by a single pathogen. In Romania, its reported incidence rate in 2024 was approximately 60 per 100,000 people, making it the country with the highest incidence in Europe. Rheumatoid arthritis (RA) is a systemic chronic autoimmune inflammatory disease characterized by the destruction of the small joints along with symmetrical distribution and multiorgan involvement. Pulmonary manifestations are more common in males with positive serology and can involve the lungs, airways, or pleura. Short-term corticotherapy may be initiated in patients with severe symptoms, and biological therapy (anti-TNF alpha drugs) may be used in those with inefficiency of disease-modifying antirheumatic drugs, with an increased risk for disseminated forms of tuberculosis in those with latent infection.Case description We present the case of a 38-year-old male patient with a 5-year history of seropositive RA who was treated with methotrexate and methylprednisolone, without any prior investigations for latent tuberculosis infection or any chest radiography performed, and was admitted with severe respiratory failure. The results of thoracic computed tomography showed bilateral pneumothorax and pneumomediastinum, with pulmonary lesions suggestive of a diagnosis of tuberculosis, which was confirmed by bacteriological testing of samples.Conclusion The coexistence of two severe diseases-one requiring immunosuppressive treatment and the other one favored by immunosuppression-in a country with a high prevalence of tuberculosis infection and in the absence of latent tuberculosis infection screening or periodic pulmonological assessment can lead to severe, life-threatening complications that require complex, multidisciplinary, long-term, and expensive management.
SN - 2296-858X
ER -