{
  "abstract": "Tumour necrosis factor-alpha (TNF-α) inhibition increases the risk of tuberculosis (TB), including disseminated and miliary disease. Although screening for latent TB is recommended before anti-TNF therapy, negative or indeterminate interferon-gamma release assay (IGRA) results do not exclude active TB, particularly in immunosuppressed patients. We report a 32-year-old man with ulcerative colitis who developed progressive respiratory and constitutional symptoms while receiving infliximab. He developed severe hypoxaemic respiratory failure requiring high-flow nasal oxygen. Chest imaging demonstrated diffuse miliary nodularity with bilateral ground-glass changes, consolidation, and mediastinal lymphadenopathy. Despite previous negative and subsequent indeterminate QuantiFERON-TB results, the clinical and radiological findings prompted empirical anti-tuberculous treatment while respiratory samples were obtained. Sputum culture subsequently grew Mycobacterium tuberculosis, while a Hain molecular assay and bronchial washing confirmed the M. tuberculosis complex. Infliximab was withheld, and the patient improved clinically, with respiratory support reduced from high-flow nasal oxygen to conventional oxygen. He subsequently reported symptomatic improvement during respiratory follow-up. This case highlights the limitations of TB screening tests in patients receiving anti-TNF therapy and demonstrates that a negative or indeterminate interferon-gamma release assay (IGRA) should not delay investigation for active TB when clinical and radiological features are strongly suggestive.",
  "abstract_shown": true,
  "affiliations": [
    "Cardiology, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-Under-Lyne, GBR.",
    "Internal Medicine, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-Under-Lyne, GBR.",
    "Acute Medicine, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-Under-Lyne, GBR.",
    "Acute medicine, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-Under-Lyne, GBR."
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Adel Kenawi"
    },
    {
      "affs": [
        1
      ],
      "name": "Nomaan Zahid"
    },
    {
      "affs": [
        2
      ],
      "name": "Mohammad Humeda"
    },
    {
      "affs": [
        3
      ],
      "name": "Ahmed Arbab"
    },
    {
      "affs": [
        1
      ],
      "name": "Marwa Ruziek"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/0ay31z5h91c50.bib",
  "cited_by": 0,
  "doi": "10.7759/cureus.117581",
  "fulltext_url": "https://europepmc.org/articles/PMC13741322",
  "id": "0ay31z5h91c50",
  "issns": [
    "2168-8184"
  ],
  "landing_url": "https://europepmc.org/article/MED/42997432",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2725|Tuberculosis Research and Epidemiology"
    ]
  ],
  "openalex": "W7220832391",
  "pdf_url": "https://europepmc.org/articles/PMC13741322?pdf=render",
  "pmcid": "PMC13741322",
  "pmid": "42997432",
  "published": "2026-10-07",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/0ay31z5h91c50.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T15:20:41Z",
      "native_id": "MED:42997432",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42997432"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2725|Tuberculosis Research and Epidemiology",
      "subfield": "infectious-disease"
    }
  ],
  "title": "Miliary-Pattern Pulmonary Tuberculosis During Infliximab Therapy Despite Negative Tuberculosis Screening.",
  "title_text": "Miliary-Pattern Pulmonary Tuberculosis During Infliximab Therapy Despite Negative Tuberculosis Screening.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T15:20:41Z",
  "url": "https://research.draconitic.com/paper/0ay31z5h91c50",
  "venue": "Cureus",
  "versions": []
}