Tuberculosis during TNF-α inhibitor therapy, despite screening

Area of Science:

• Immunology
• Infectious Diseases
• Pharmacology

Background:

• Tumor necrosis factor-alpha (TNF-α) inhibitors are used in treating various inflammatory conditions.
• Screening for latent tuberculosis infection (LTBI) is standard practice before initiating TNF-α inhibitor therapy.
• LTBI screening aims to mitigate the risk of reactivation tuberculosis during immunosuppression.

Observation:

• Two patients on TNF-α inhibitor therapy developed active tuberculosis (TB).
• Both patients had negative LTBI screening prior to and during therapy.
• Clinical history suggested primary TB infection acquired during travel to TB-endemic regions.

Findings:

• Standard LTBI screening may not be sufficient to prevent TB in patients receiving TNF-α inhibitors.
• Primary TB infection acquired during travel poses a significant risk.
• TNF-α inhibitor therapy may increase susceptibility to new TB infections.

Implications:

• Enhanced vigilance for TB is crucial in patients on TNF-α inhibitors, especially those who travel.
• Rethinking screening protocols for LTBI in patients with travel history to endemic areas is warranted.
• The risk of primary TB infection should be considered alongside reactivation risk in this patient population.