Late onset tuberculosis infection in patients receiving anti-TNF therapy

Abstract

### Learning Point for Clinicians This report demonstrates that tuberculosis (TB) is a significant problem in patients receiving anti-tumor necrosis factor alpha (TNFα) therapy. TB may occur despite pre-treatment screening. The onset may be delayed and associated with significant morbidity and mortality. In particular, response to treatment may be slow and the disease may progress before coming under control. A 58-year-old male presented with a 4-week history of high-grade fevers, night sweats and malaise. He denied any respiratory symptoms. He had a history of psoriatic arthritis and had been treated with infliximab for 5 years and subsequently switched to adalimumab. Prior to institution of infliximab, a Mantoux test had been negative and chest X-ray normal. Examination was unremarkable apart from a fever of 39°C. Chest X-ray was normal, white cell count was 8.6, erythrocyte sedimentation rate was 20 and …