title: Radiological manifestations of pulmonary tuberculosis in patients subjected to anti-TNF-α treatment.
abstract: METHODS
  The risk of pulmonary tuberculosis (PTB) may increase with increased use of anti-tumour necrosis factor (TNF) treatment in inflammatory arthritis.
  
  
  OBJECTIVE
  To evaluate the impact of anti-TNF treatment on radiological manifestations of PTB.
  
  
  METHODS
  Between January 2007 and December 2012, the chest radiographs (CXRs) of 23 consecutive patients with newly diagnosed PTB who underwent anti-TNF treatment were studied. Chest computed tomography (CT) images were available for 14. To compare the radiological features of PTB, the CXRs of 46 immunocompetent PTB patients with similar demographics were studied as controls, of whom 34 underwent chest CT. Two radiologists and one chest physician reviewed the chest images independently.
  
  
  RESULTS
  Compared with the controls, fibronodular lesions were less common on CXR in the anti-TNF group (P < 0.001). In contrast, lymphadenopathy (P < 0.001), pleural effusion (P = 0.015) and pericardial effusion (P = 0.02) were more common, while tree-in-bud appearance (P = 0.017) was less commonly depicted on chest CT in the anti-TNF group. Although there was no significant difference in zonal predilection and laterality of the lesions between the two groups, diffuse lesions (P = 0.004) on chest CT scans were more frequent in the anti-TNF group.
  
  
  CONCLUSIONS
  Unusual presentations of PTB were more common in the CXRs and/or CT scans of patients who underwent anti-TNF treatment.
authors.affiliation: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: L-K
authors.initials: LK
authors.lastname: Huang
authors.affiliation: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: M-H
authors.initials: MH
authors.lastname: Wu
authors.affiliation: Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: S-C
authors.initials: SC
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D001168:Arthritis / Q000188:drug therapy* / Q000276:immunology; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008168:Lung / Q000000981:diagnostic imaging* / Q000276:immunology / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000139:chemically induced / Q000000981:diagnostic imaging* / Q000276:immunology; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014397:Tuberculosis, Pulmonary / Q000139:chemically induced / Q000000981:diagnostic imaging* / Q000276:immunology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000378:metabolism; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D014409:Tumor Necrosis Factor-alpha