De novo Tuberculosis during Anti-tumor Necrosis Factor-alpha Therapy in a Rheumatoid Arthritis Patient with Negative Initial Screening

Tuberculosis is a major concern in patients with rheumatologic disorders under immunosuppressive therapy. In this paper a 67-year old woman is presented with seropositive rheumatoid arthritis and negative screening for latent tuberculosis. She was treated with infliximab since 22 months ago. She developed constitutional and respiratory manifestations and flare of articular symptoms during treatment by immunosuppressive agents. Tuberculosis clinical presentation and investigation tests including imaging, pleural effusion analysis and interferon γ release assay (IGRA) estimation and anti-tuberculosis treatment was initiated and dose of prednisolone was increased. Afterwards, constitutional respiratory and articular signs improved significantly. Beside of initial screening, attention to tuberculosis in patients being treated with biologic drugs should be done at any time.