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Infectious Diseases
Disseminated MDR-TB missed in a patient treated with TNF inhibitor
  1. Sophie Dam Harmundal Hansen1,
  2. Frauke Rudolf1,
  3. Nina Schram Gregersen2 and
  4. Anders Norman3
  1. 1 Department of Infectious Diseases, Aarhus Universitetshospital, Aarhus, Denmark
  2. 2 Department of Clinical Medicine, Regionshospitalet Godstrup, Herning, Denmark
  3. 3 Statens Serum Institut, Kobenhavn, Denmark
  1. Correspondence to Ms Sophie Dam Harmundal Hansen; sophhs{at}rm.dk

Abstract

A previously healthy man developed pulmonary symptoms 2 weeks after starting treatment with a tumour necrosis factor (TNF) inhibitor. A negative interferon-gamma release assay (IGRA) test was obtained prior to TNF inhibitor exposure, without consideration of the fact that the patient was already immunosuppressed and had a previous positive IGRA test 17 months earlier. The patient was treated for pneumonia twice but did not achieve remission. His physical health progressively deteriorated over the following months. Malignancy was suspected but not found. Eight months after the onset of symptoms, Mycobacterium tuberculosis was found in samples from mediastinal lymph nodes, and the patient was diagnosed with multidrug-resistant tuberculosis (MDR-TB).

This case illustrates the diagnostic challenge of TB, the need to raise awareness of the increased risk of TB in patients treated with TNF inhibitors and the need to increase knowledge regarding the effect of immunosuppressive agents on IGRA tests.

  • Infections
  • Respiratory system
  • Pneumonia (infectious disease)
  • TB and other respiratory infections
  • Tuberculosis

https://doi.org/10.1136/bcr-2024-260058

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    Footnotes

    • X @anders_norman

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: SDHH, FR, NSG and AN. The following authors gave final approval of the manuscript: SDHH, FR, NSG and AN. ChatGPT: Academic Assistant was used solely for minor grammatical concerns, as English is not the first language of any of the authors. ChatGPT: Academic Assistant was not used for any research or data provided in this manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.