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Chronic myeloid leukaemia and tuberculosis in a patient with rheumatoid arthritis treated with infliximab
  1. F Broussais,
  2. M Kawashima,
  3. H Marotte,
  4. P Miossec
  1. Departments of Immunology and Rheumatology and HCL-bioMérieux Research Unit on Rheumatoid Arthritis, Lyon, France
  1. Correspondence to:
    Professor P Miossec
    Clinical Immunology Unit, Departments of Immunology and Rheumatology, Hôpital Edouard Hérriot, 69437 Lyon Cedex 03, France; miossecuniv-lyon1.fr

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Cases of lymphoma and tuberculosis (TB) have been described in patients receiving tumour necrosis factor α (TNFα) inhibitors.1,2 We report a case of chronic myeloid leukaemia (CML) and TB, where molecular markers could be followed in a rheumatoid patient treated with infliximab.

CASE REPORT

A 56 year old white woman, with a 2 year history of refractory and destructive rheumatoid arthritis (RA), had been treated with methotrexate (MTX, 10 mg/week). As this was not effective, MTX was increased to 15 mg/week, and she received a total amount of about 1250 mg. Because of persistent active disease and high erythrocyte sedimentation rate (44 mm/1st h) with high platelet count at 0.6×1012/l, infliximab was combined with MTX (15 mg/week) in August 2001 at 3 mg/kg every 8 weeks.3 It should be noted that at that time TB prophylaxis before starting anti-TNFα treatment was not yet organised as it is today.

Although the disease improved, thrombocytosis, first considered as possibly related to inflammation, increased up to 1.1×1012/l in January 2002. Bone marrow aspiration demonstrated …

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