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Selective tuberculin anergy: case report and review

M A Montecalvo¹, G P Wormser

¹Department of Medicine, New York Medical College, Valhalla.

The Mount Sinai Journal of Medicine, New York

|September 1, 1994

Summary

Tuberculin skin testing for tuberculosis can be unreliable due to anergy, a reduced immune response. Selective anergy, where patients react to other antigens but not tuberculosis, is a poorly understood phenomenon.

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Area of Science:

Immunology
Infectious Diseases
Public Health

Background:

The human immunodeficiency virus epidemic necessitates accurate tuberculosis diagnosis.
Tuberculin skin testing (TST) is crucial for diagnosing Mycobacterium tuberculosis infection.
Anergy, or a diminished skin test response, can complicate TST interpretation, especially in immunocompromised individuals.

Observation:

Selective anergy can occur, where patients exhibit a negative TST despite active tuberculosis, even when reacting to other recall antigens.
This phenomenon is poorly understood and can lead to misdiagnosis.
An illustrative case of selective anergy in a patient with tuberculous meningitis is presented.

Findings:

Selective anergy to purified protein derivative (PPD) tuberculin can occur despite positive reactions to other antigens.
This selective anergy complicates the interpretation of negative TST results.
Repeating a 5-unit PPD-TST after four to eight weeks of antituberculous treatment may aid in diagnosis.

Implications:

Understanding selective anergy is vital for accurate tuberculosis diagnosis, particularly in high-risk populations.
Clinicians should consider selective anergy when interpreting negative TST results in suspected tuberculosis cases.
Further research into the mechanisms and management of selective anergy is warranted to improve tuberculosis control strategies.

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