ArticleJournal of clinical tuberculosis and other mycobacterial diseases2026
Challenges in tuberculosis screening before TNF-α inhibitors: A case report highlighting gaps in current practice.
Article in Journal of clinical tuberculosis and other mycobacterial diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
We present the case of a 34-year-old Polish man with a history of axial spondyloarthritis and Crohn's disease, who presented with respiratory and neurological symptoms whilst on TNF-α inhibitors treatment. He subsequently developed a fulminant pulmonary tuberculosis (TB) with cerebral involvement. Treatment was complicated by a paradoxical reaction and respiratory failure requiring intensive care admission. This case highlights the diagnostic challenges associated with TB screening prior to immunosuppressive therapy and underscores the limitations of single-test screening protocols. It further emphasizes that, in immunocompromised patients, both IGRA and TST have reduced sensitivity, and a dual testing strategy with repeated, risk-based screening may improve detection in selected high-risk populations. This case also demonstrates that tuberculosis in immunosuppressed patients can follow a fulminant course, and that early detection and timely initiation of appropriate therapy are essential determinants of clinical outcome.
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