The introduction of biological agents, especially the tumor necrosis factor inhibitors (anti-TNF), for the treatment of rheumatic diseases increased the risk of developing tuberculosis (TB). Screening for latent TB infection (LTBI) is strongly recommended before starting therapy with anti-TNF agents. The objective of this study was to identify the prevalence of LTBI and TB among patients with rheumatic diseases on anti-TNF agents. This is a cross-sectional study. The electronic medical records of all adult patients (≥18 years old) undergoing anti-TNF treatment were reviewed. Every patient underwent tuberculin skin test (TST) before starting anti-TNF treatment. In total, 176 patients were included; the mean age was 51.9 ± 12.4 years, 34.7% were males, and 90.9% were white. The underlying diseases were rheumatoid arthritis (RA) in 50.6% (N = 89), ankylosing spondylitis (AS) in 27.8% (N = 49), and psoriatic arthritis (PsA) in 17.6% (N = 31). The prevalence of positive TST was 29.5%. Household contact with TB was significantly associated with a positive TST (p = 0.020). RA patients had lower TST reactions than AS patients (p = 0.022). There were six cases of TB (3.4%) diagnosed during anti-TNF therapy. We demonstrated a high prevalence of positive TST (29.5%) among patients with rheumatic diseases in a region with high TB prevalence. Our data corroborates the ACR's recommendation that patients who live in high TB incidence settings should be tested annually for LTBI.
The findings of our study suggest superiority of the USG approach in terms of first puncture success rate and technique failure, without increasing the procedure duration. Long-term follow-up results should help to further clarify the current debates.
Bullous SDRIFE and Covid-19Dear Editor, Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) is a drug reaction with well-defined criteria and some clinical and histopathological variability, in addition to simultaneous overlapping features with other pharmacological reactions. 1,2 We report a special case of SDRIFE with bullae formation in a patient with severe COVID-19, a situation that is unmatched in the literature. A 53-year-old obese woman with diabetes mellitus, chronic obstructive pulmonary disease, and a diagnosis of COVID-19 made 21 days earlier was admitted to the intensive care unit (ICU) with respiratory failure, bacterial pneumonia (Pseudomonas aeruginosa), intravascular device-related blood-
Although the PCR specificity could be underestimated, if we consider PCR to be more sensitive than the culture method used, we believed that these PCR-positive tests mean false positives. The results of PCR should always be interpreted carefully in conjunction with clinical information.
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