Infliximab Therapy Leading to Pulmonary Tuberculosis in a Patient With Negative Interferon γ Release Assay (IGRA)-Based QuantiFERON Gold Test

Abstract

Infliximab therapy is associated with higher rates of active tuberculosis (TB), particularly extrapulmonary and disseminated forms with unusual symptoms. We report the case of a 66-year-old man with Crohn’s disease who developed TB mimicking lung cancer on imaging. He presented with cough and fever of 2 weeks’ duration shortly after starting infliximab. Computed tomography of the chest revealed a 7.0 × 3.2 cm2 pleural-based mass, highly suspicious for malignancy. Histopathological examination confirmed the diagnosis of TB. The mass disappeared after antitubercular treatment, and the patient recovered completely. A review of the literature suggests that TB masquerades as lung cancer clinically and radiologically. The classical lesions of TB are cavitatory with calcifications. Mass lesions without cavity or calcifications are rare and are mostly reported from regions endemic for TB. The majority of patients on infliximab therapy required biopsy for accurate diagnosis of TB because of its unusual presentation.

Different forms of mycobacterial infections in patients receiving anti-TNF therapy: Case reports

“…Tuberculosis develops soon after initiation of therapy with TNF-alpha antagonists. When infliximab is used, almost in half of cases TB occurs within the first 90 days (12 weeks) since the beginning of therapy, which most probably indicates the reactivation of LTBI (7). TB infection following etanercept treatment occurs less often and later on in the treatment in comparison with infliximab and adalimumab.…”

“…Tuberkuloza nastaje vrlo brzo od početka terapije antagonistima TNF-alfa. Kod upotrebe infliksimaba u skoro polovini slučajeva tuberkuloza se javlja u prvih 90 dana (12 nedelja) od početka njegove primene, što ukazuje da je najverovatnije reč o reaktivaciji LTBI (7). TB infekcija udružena sa primenom etanercepta nastaje ređe i kasnije u odnosu na infliksimab i adalimumab.…”