ArticleFrontiers in medicine2026
Case Report: delayed recognition of pulmonary tuberculosis during immunosuppression for suspected connective tissue disease.
Article in Frontiers in medicine, 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
Background: Pulmonary tuberculosis may be difficult to recognize in patients receiving immunosuppression for suspected connective tissue disease, because clinical symptoms, inflammatory markers, pulmonary abnormalities, and imaging findings may be attributed to autoimmune disease activity. Case presentation: A 57-year-old woman with dry mouth, myalgia, arthralgia, and positivity for antinuclear antibody (ANA) and anti-SSA/SSB antibodies was initially considered to have Sjögren syndrome or undifferentiated connective tissue disease. She sequentially received glucocorticoids, belimumab, tocilizumab, and baricitinib. During treatment, she developed recurrent low-grade fever, marked weight loss, pulmonary nodules and consolidation, mediastinal lymphadenopathy, and painful subcutaneous nodules. Three TB-related T-cell immunological assays were negative, including two interferon-gamma release assay tests and one T-SPOT. TB assay. Biopsy of a subcutaneous lesion showed acute and chronic inflammation with suspected granuloma formation, and next-generation sequencing of the tissue did not identify a causative pathogen. Because fever persisted and respiratory symptoms subsequently developed, an infectious etiology was reconsidered, and respiratory microbiological testing was repeated. The sputum acid-fast bacilli smear was positive (3+), Conclusion: Negative IGRA-related tests should not be used to exclude active TB in immunosuppressed patients. Persistent fever, weight loss, pulmonary lesions, lymphadenopathy, or granulomatous inflammation should prompt repeat microbiological testing before escalation of immunosuppression.
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