The Challenge of Tuberculosis Infection Related to Adalimumab: A Subtle and Rare Presentation

Juliana Lopes, Ana Machado, Sara Martins, Sara Pires, Catarina Branco, Joana Fragoso, Diogo Guerra, Patricia Campos, Mariana Brandao, Graziela Carvalheiras, Teresa Mendonca


With the increasing use of biological therapies, there was a concomitant increase in concern and sensitivity for associated opportunistic infections. There has been growing evidence that anti-tumor necrosis factor (TNF) therapy increases the risk of opportunistic infection. Screening for latent tuberculosis (TB) prior to initiation of therapy has reduced the incidence of active TB, although it is not completely preventable. The possibility of active TB should always be considered in immunosuppressed patients under anti-TNF therapy. We report a case of muscular TB with psoas abscess in a patient under adalimumab. This case highlights the importance of the high suspicion threshold for Mycobacterium tuberculosis infection, in patients with subtle symptoms.

J Med Cases. 2018;9(1):23-25


Tuberculosis; Psoas muscle abscess; Anti-TNF; Adalimumab; Intestinal Behcet

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