Early screening to identify and diagnose primary nasal tuberculosis in patients with tumor necrosis factor inhibitors

In this editorial, we comment on the article by Liu et al. Based on our analysis of a case report, we consider that early screening and recognition of primary nasal tuberculosis are crucial for patients undergoing treatment with tumor necrosis factor inhibitor (TNFi). While TNFi therapy increases the risk of reactivating latent tuberculosis, primary nasal tuberculosis remains rare due to the protective mechanisms of the nasal mucosa. Risk factors for primary nasal tuberculosis include minimally invasive nasal surgery, diabetes, and human immunodeficiency virus. Patients with early symptoms such as nasal congestion, rhinorrhea, altered olfaction, epistaxis, or ulceration, and unresponsive to conventional antibiotics and antihistamines should undergo early rhinoscopy, possibly followed by repeated tissue biopsies and acid-fast bacilli culture when necessary. When diagnosis is challenging, it is essential to consider local tuberculosis epidemiology and the efficacy of diagnostic anti-tuberculosis treatment. The preferred method for tuberculosis screening is the Interferon Gamma Release Assay, with a general recommendation for screening at 3 and 6 months after initial treatment and then every six months. However, the optimal frequency is not yet consensus-driven and may be increased in economically viable settings.