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Related Experiment Videos

Miliary Tuberculosis in a Crohn's Disease Patient: The Risk beyond the Screening.

Liliana Pereira Carvalho1, Maria Ana Túlio1, José Pedro Rodrigues1

  • 1Gastroenterology Department of Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.

GE Portuguese Journal of Gastroenterology
|January 25, 2019
PubMed
Summary

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Tumor necrosis factor alpha (TNFα) antagonists effectively treat Crohn's disease but carry infection risks. This case highlights the challenge of diagnosing tuberculosis despite negative screening in patients on anti-TNFα therapy.

Area of Science:

  • Immunology
  • Gastroenterology
  • Infectious Diseases

Background:

  • Anti-TNFα therapy is crucial for managing moderate-to-severe Crohn's disease, offering clinical remission and mucosal healing.
  • TNFα antagonists modulate the immune system, raising concerns about increased susceptibility to opportunistic infections, notably tuberculosis (TB).
  • Screening for latent TB infection is standard practice before initiating anti-TNFα therapy due to the high incidence and severity of TB in immunocompromised individuals.

Observation:

  • A Crohn's disease patient on infliximab and azathioprine developed miliary tuberculosis.
  • The patient had negative screening for latent TB infection using interferon-γ release assays prior to treatment.
  • Diagnosis of TB was challenging due to its disseminated and extrapulmonary presentation.

Findings:

Keywords:
Anti-TNFα therapyCrohn's diseaseInterferon-γ release assaysMiliary tuberculosis

Related Experiment Videos

  • Despite negative latent TB screening, active TB infection can still occur during anti-TNFα therapy.
  • Tuberculosis in patients on anti-TNFα therapy presents atypically, complicating diagnosis.
  • Treatment of TB in this context is difficult due to drug resistance and associated high morbidity and mortality.

Implications:

  • This case underscores the need for heightened awareness regarding TB risk in patients receiving anti-TNFα therapy.
  • Current screening methods may not entirely eliminate the risk of active TB infection.
  • Developing improved diagnostic and therapeutic strategies for TB in anti-TNFα-treated patients is essential for better patient outcomes.