PT  - JOURNAL ARTICLE
AU  - Sanket Patel
AU  - Martin Douglas Weaver
AU  - Satyajeet Roy
TI  - Miliary tuberculosis and herpes pharyngitis after a trip to a developing country: dangers of biologics
AID  - 10.1136/bcr-2018-224459
DP  - 2018 Oct 02
TA  - BMJ Case Reports
PG  - bcr-2018-224459
VI  - 2018
4099  - http://casereports.bmj.com/content/2018/bcr-2018-224459.short
4100  - http://casereports.bmj.com/content/2018/bcr-2018-224459.full
AB  - The use of biologic drugs has expanded since its introduction in the late 1990s. With growing medical use and newer biologic drugs in development, opportunistic infections like Mycobacterium tuberculosis remain important adverse effects. It carries major public health concerns, yet evidence-based clinical guidelines for more routine interval screening in patients taking immunosuppressants and exposed to tuberculosis (TB) are lacking. We illustrate a case of an elderly Indian-born man living in the USA with psoriatic arthritis who was on adalimumab for 10 years. He presented with disseminated TB and herpes simplex virus type 1 (HSV-1) pharyngitis, a year after an innocuous trip to India. Our case draws attention to the adverse effects of biologic drugs and highlights the importance of regular rescreening for a high-risk population. As the use of biologic treatment increases, physicians must be vigilant in more frequent screening, monitoring and identifying related opportunistic infections, notably M. tuberculosis infections.