Karam Karam¹, Johny Salem², Jessy Fadel³, Mazen Farhat³, Lara Dalal⁴, Jose Taouk⁵, Marwan Haddad⁶, Bassem Sawan⁷, Charbel Fares⁶ and Elias Fiani⁸*

¹Department of Gastroenterology, University of Balamand (UOB), Koura, Lebanon
²Department of Internal Medicine, University of Balamand, Koura (UOB), Lebanon
³Department of Gastroenterology, Saint Georges University of Beirut (SGUB), Beirut, Lebanon
⁴Faculty of Medicine, University of Balamand, Koura, Lebanon
⁵Department of Medical Imaging, University of Balamand, Beirut, Lebanon
⁶Department of Diagnostic Radiology, Mount Lebanon Hospital, Beirut, Lebanon
⁷Department of Pathology, Saint George Hospital University Medical Center, Beirut, Lebanon
⁸Department of Gastroenterology and Hepatology, Saint George Hospital University Medical Center, Beirut, Lebanon

*Corresponding Author: Elias Fiani, Department of Gastroenterology and Hepatology, Saint George Hospital University Medical Center, Beirut, Lebanon.

Received: April 26, 2024; Published: May 20, 2024

Abstract

Adalimumab (ADA) is a tumor necrosis factor (TNF) inhibitor commonly used in inflammatory diseases like rheumatoid arthritis and inflammatory bowel disease due to its immunosuppressive effect through TNF alpha blockade. However, this treatment presents with the risk of contracting opportunistic infections like Tuberculosis (TB) that may be missed during initial screening. We discuss a case of an extrapulmonary miliary TB presenting 11 months after starting Adalimumab for treatment of Crohn’s disease, despite negative screening with tuberculin skin testing (TST). We discuss the appropriate screening modality to reduce false-negative latent TB screening prior to starting TNF inhibitors for patients diagnosed with Crohn’s disease.

Keywords: Adalimumab; Anti-tumor Necrosis Factor α; Miliary Tuberculosis; Extrapulmonary Tuberculosis; Crohn’s Disease; Interferon-γ Release Assays

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Citation

Citation: Elias Fiani., et al. “Pitfalls of a Negative Tuberculin Skin Test When Used as a Screening Modality for Latent Tuberculosis Prior to Adalimumab Therapy: A Case Report". Acta Scientific Gastrointestinal Disorders 7.6 (2024): 08-11.

Copyright

Copyright: © 2024 Elias Fiani., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.