Two Cases of Tuberculosis Complicating Treatment With Tumor Necrosis Factor-alpha Inhibitors

TNF-alpha blocking agents have been increasingly used in the treatment of systemic inflammatory diseases. The main adverse effect of these drugs is susceptibility to infections, mainly reactivation of latent tuberculous infection (LTBI). In this paper we described two cases of TNF-alpha inhibitor-associated TB. Because LTBI and BCG vaccination are widespread in the Turkish population, a stringent pre-treatment screening protocol for LTBI should be used. In such patients, TB frequently presents as an extrapulmonary or disseminated and life-threatening disease. Physicians should be aware of the risk of the reactivation of TB, despite isoniazid chemoprophylaxis, with unusual clinical manifestations and a paradoxical response.