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Latent tuberculosis before biologic therapy — ABIM Board MCQ

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ModerateInfectious DiseaseLatent tuberculosis before biologic therapyABIM Board

A 50-year-old man with rheumatoid arthritis is scheduled to start a TNF inhibitor. Interferon-gamma release assay is positive. Chest radiograph is normal and he has no cough, fever, night sweats, or weight loss. HIV testing is negative. Which of the following is the most appropriate management?

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Correct answer: A — Treat latent tuberculosis infection before TNF inhibitor therapy

A positive TB screening test with no clinical or radiographic evidence of active disease is latent TB infection. Treatment before TNF inhibitor therapy reduces risk of reactivation.

Reference: CDC/NTCA Latent Tuberculosis Infection Treatment Guidance; IDSA TB Guidance