A 45 years old male patient a known case of Crohn's disease presents with recent flare-ups suggestive of fistulas. He was admitted and treated with immune-suppressive. Unfortunately, he got reactivation of his tuberculosis as a result of the side effects of the treatment. Which of the following immunosuppressive medication is the most likely cause of his TB reactivation?
Answer: b) InfliximabTREATMENT OF INFLAMMATORY BOWEL DISEASEAminosalicylates* 5-aminosalicylic acid (formulations known as mesalamine): acts topically in the colon.* Sulfasalazine (5-ASA + sulphapyridine), olsalazine (5-ASA+5-ASA) and balsalazide (5-ASA+ amino benzoyl Alanine) are effective for the treatment of ulcerative colitis.* 5-ASA is the first line treatment for mild ulcerative colitis.Glucocorticoids* Prednisone, hydrocortisone, prednisolone and budesonide: in moderate to severe ulcerative colitis and Crohn's disease.Purine analogs* Azathioprine and 6-MP: maintenance for remission of ulcerative colitis and Crohn's disease.Methotrexate: induction and maintenance of remission of Crohn's disease but not ulcerative colitis.Anti TNFa therapy: Infliximab, adalimumab and certolizumab are useful in Crohn's disease.Natalizumab: targeted against a-4 subunit of integrins. Should not be used with other immunosuppressants due to the risk of progressive multifocal leukoencephalopathy.* Infliximab therapy is associated with | incidence of respiratory infections; potential reactivation of tuberculosis or other granulomatous infections with subsequent dissemination.* Candidates for infliximab therapy should be tested for latent tuberculosis with purified protein derivative and chest radiographs, and patients who test positive should be treated prophylactically with isoniozid.* Infliximab also is contraindicated in patients with severe congestive heart failure.
Methotrexate
Infliximab
Azathioprine
Mizorbine
Immunomodulator