Conversion to positive tuberculosis test during etanercept treatment of psoriasis

The use of tumor necrosis factor alpha inhibitors (TNF-alpha) for psoriasis has raised greater awareness of tuberculosis screening. Tuberculosis can be acquired during foreign travel and also within the US by exposure to infected persons. We present a patient who converted to a positive purified protein derivative test (PPD) during anti-TNF-alpha treatment of psoriasis. PPD testing prior to any immunosuppressive treatment may be prudent, especially considering the benign nature and low cost of the test. As illustrated by this case, one may wish to consider annual tuberculosis testing for these patients.