title: Tuberculosis infection following anti-TNF therapy in inflammatory bowel disease, despite negative screening.
abstract: We present two patients with inflammatory bowel disease who, despite negative tuberculosis screening, developed a de novo tuberculosis infection after the start of anti tumor necrosis factor alpha treatment. We discuss current screening methods and their limitations, the approach after positive screening and the timing to resume anti-TNFα treatment after TB infection. We shortly mention the immune reconstitution inflammatory syndrome (IRIS), described in a few cases after the stop of anti-TNFalpha while treating the tuberculosis infection. We conclude with some remaining questions concerning tuberculosis in IBD patients.
authors.affiliation: Department of Internal Medicine, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.
authors.forename: Celine
authors.initials: C
authors.lastname: Debeuckelaere
authors.affiliation: Department of Infectious Diseases, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.
authors.forename: Paul
authors.initials: P
authors.lastname: De Munter
authors.affiliation: Department of Respiratory Division, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.
authors.forename: Pascal
authors.initials: P
authors.lastname: Van Bleyenbergh
authors.affiliation: Department of Radiology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.
authors.forename: Walter
authors.initials: W
authors.lastname: De Wever
authors.affiliation: Department of Gastroenterology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.
authors.forename: Gert
authors.initials: G
authors.lastname: Van Assche
authors.affiliation: Department of Gastroenterology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.
authors.forename: Paul
authors.initials: P
authors.lastname: Rutgeerts
authors.affiliation: Department of Gastroenterology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium. Electronic address: Severine.Vermeire@uzleuven.be.
authors.forename: Severine
authors.initials: S
authors.lastname: Vermeire
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000150:complications* / Q000188:drug therapy; D003424:Crohn Disease / Q000150:complications* / Q000188:drug therapy; D005188:False Negative Reactions; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D014397:Tuberculosis, Pulmonary / Q000139:chemically induced / Q000175:diagnosis / Q000209:etiology*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab
keywords: Anti-TNFα; Anti-tuberculous therapy; De novo tuberculosis; IBD; Immune reconstitution inflammatory syndrome; Screening