Miliary-Pattern Pulmonary Tuberculosis During Infliximab Therapy Despite Negative Tuberculosis Screening.
4 affiliations
- 1Cardiology, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-Under-Lyne, GBR.
- 2Internal Medicine, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-Under-Lyne, GBR.
- 3Acute Medicine, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-Under-Lyne, GBR.
- 4Acute medicine, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-Under-Lyne, GBR.
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.
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BibTeX
@article{kenawi2026miliarypattern,
title = {{Miliary-Pattern Pulmonary Tuberculosis During Infliximab Therapy Despite Negative Tuberculosis Screening.}},
author = {Adel Kenawi and Nomaan Zahid and Mohammad Humeda and Ahmed Arbab and Marwa Ruziek},
journal = {Cureus},
year = {2026},
month = oct,
doi = {10.7759/cureus.117581},
url = {https://europepmc.org/article/MED/42997432},
note = {CC BY},
}
RIS
TY - JOUR
TI - Miliary-Pattern Pulmonary Tuberculosis During Infliximab Therapy Despite Negative Tuberculosis Screening.
AU - Adel Kenawi
AU - Nomaan Zahid
AU - Mohammad Humeda
AU - Ahmed Arbab
AU - Marwa Ruziek
PY - 2026
DA - 2026/10/07
JO - Cureus
DO - 10.7759/cureus.117581
UR - https://europepmc.org/article/MED/42997432
AB - 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.
SN - 2168-8184
ER -