Disseminated Tuberculosis Associated With Adalimumab Therapy

Area of Science:

• Rheumatology
• Infectious Diseases
• Immunology

Background:

• Anti-tumour necrosis factor alpha (anti-TNF-α) therapies are crucial for rheumatologic diseases.
• Opportunistic infections, including tuberculosis (TB), are potential risks associated with immunosuppression.
• Screening for latent TB infection (LTBI) is standard practice before initiating anti-TNF-α therapy.

Observation:

• A 62-year-old male with psoriatic arthritis on adalimumab for 5 years presented with constitutional symptoms and memory loss.
• Initial and follow-up LTBI screening tests (interferon gamma release assay) were negative.
• Despite negative screenings, the patient was diagnosed with disseminated TB affecting the brain, lungs, and peritoneum.

Findings:

• Disseminated tuberculosis can occur despite negative LTBI screening in patients on adalimumab.
• Latent TB screening tests may have limitations in sensitivity.
• Immunosuppressive therapy with adalimumab can reactivate or unmask latent TB, leading to disseminated disease.

Implications:

• This case underscores the importance of considering TB in patients on anti-TNF-α therapy presenting with suggestive symptoms, regardless of prior negative screening.
• Diagnostic challenges in TB necessitate a high index of suspicion and thorough workup.
• Management strategies for disseminated TB in immunocompromised patients require careful consideration of the underlying immunosuppressive treatment.