Dos casos de reactivación de tuberculosis pulmonar por infliximab: Problemas y propuestas de solución

introduction: there are numerous risk factors for the development of tuberculosis (tb); one recently known is immunosupression produced by infliximab, a chimeric anti-tumor necrosis factor alpha monoclonal antibody used, amongst others, in rheumatoid arthritis, ankylosing spondylitis and crohn's disease; several cases of reactivation of pulmonary tb have been reported in the united states of america and europe. cases presentation: only one case of reactivation of pulmonary tb has been reported in mexico. we now present two more cases in patients with hla-b27 spondyloarthropathy refractory to usual drug management; one occurred in a 23 year old woman after the second dose of infliximab; the other in a 32 year old male, after the fifth dose during the fifth month of treatment. both developed a cavitating pneumonia, with complete resolution after standard outpatient tb chemotherapy and discontinuation of infliximab. discussion: the bibliographic review includes the relationship between infliximab and reactivation of pulmonary tb, epidemiology of tuberculosis in mexico, preventive measures, controversies in the detection, physiopathology and treatment suggestions for the early diagnosis and management in our socioeconomic environment