Primary tuberculosis infection in patients treated with tumor necrosis factor-alpha antagonists and a negative initial screening

Abstract

Introduction: Despite screening for latent tuberculosis (TB), new cases of TB infection are detected in patients treated with anti-TNF-α and negative initial screening, some of them after long treatment, which points more to a new infection.

Objectives: To describe the cases that have presumably developed a primary tuberculous infection during treatment with anti-TNF-α drugs.

Methods: Retrospective audit (1999-2012). Inclusion criteria were: a) anti-TNF-α treatment; b) initial latent TB screening negative; c) TB diagnosed during anti-TNF-α treatment; d) suspected primary TB infection (diagnosis after at least 12 months on anti-TNF-α). Clinical, epidemiological, therapeutic and outcome variables were reviewed.

Results: Two cases of primary TB infection were found out of of 771 anti-TNF-α treated patients (0.2%). One woman aged 41 suffered TB pneumonia after 35 months of treatment with adalimumab, and a male aged 37 who developed disseminated TB after 107 months of treatment with infliximab.

Conclusions: Although uncommon, during TNF antagonist therapy, TB risk persists despite negative initial screening, so clinicians should be aware of TB during the entire treatment.

Keywords: Anti-TNF-α; Immunosuppression; Inmunosupresión; Reactivación tuberculosis latente; Reactivating latent tuberculosis; Tuberculosis.