Tuberculosis infection following anti-TNF therapy in inflammatory bowel disease, despite negative screening

J Crohns Colitis. 2014 Jun;8(6):550-7. doi: 10.1016/j.crohns.2013.11.008. Epub 2013 Dec 2.

Abstract

We present two patients with inflammatory bowel disease who, despite negative tuberculosis screening, developed a de novo tuberculosis infection after the start of anti tumor necrosis factor alpha treatment. We discuss current screening methods and their limitations, the approach after positive screening and the timing to resume anti-TNFα treatment after TB infection. We shortly mention the immune reconstitution inflammatory syndrome (IRIS), described in a few cases after the stop of anti-TNFalpha while treating the tuberculosis infection. We conclude with some remaining questions concerning tuberculosis in IBD patients.

Keywords: Anti-TNFα; Anti-tuberculous therapy; De novo tuberculosis; IBD; Immune reconstitution inflammatory syndrome; Screening.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antibodies, Monoclonal / adverse effects*
  • Antibodies, Monoclonal / therapeutic use
  • Colitis, Ulcerative / complications*
  • Colitis, Ulcerative / drug therapy
  • Crohn Disease / complications*
  • Crohn Disease / drug therapy
  • False Negative Reactions
  • Humans
  • Infliximab
  • Male
  • Middle Aged
  • Tuberculosis, Pulmonary / chemically induced
  • Tuberculosis, Pulmonary / diagnosis
  • Tuberculosis, Pulmonary / etiology*
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*

Substances

  • Antibodies, Monoclonal
  • Tumor Necrosis Factor-alpha
  • Infliximab