Tuberculosis reactivation in patients with rheumatoid arthritis on tumor necrosis factor-alpha-blockers: A case report

Tumor necrosis factor-alpha-blockers in rheumatology have revolutionized the treatment of rheumatoid arthritis. However, they can increase the risk of latent tuberculosis reactivation. This risk is evaluated by tuberculosis skin tests and chest radiography in many nations such as Iran. The interferon-gamma release assay test is a secondary test that is used to rule out the potential risk of latent tuberculosis reactivation but is not mandatory. In this report, we aim to present a ۶۷-year-old rheumatoid arthritis female patient who was on Tumor necrosis factor-alpha-blockers (Adalimumab) and manifested severe symptoms of tuberculosis infection in our service ۸ months after taking the initial treatment. The tuberculosis skin test and chest radiography were negative at the initiation of remedy in this case. The patient was cured after a timely diagnosis and receiving treatment for tuberculosis. Mandatory double-checking with tuberculosis skin test and interferon-gamma release assays test is recommended before tumor necrosis factor-alpha-blocker prescription in rheumatoid arthritis patients to prevent the risk of fatal tuberculosis reactivation.

Keywords:

Rheumatoid arthritis , anti-tumor necrosis factor-alpha blocker , tuberculosis , interferon-gamma