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Latent tuberculosis before biologic therapy — SCE Respiratory MCQ

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ModerateTuberculosis and NTMLatent tuberculosis before biologic therapySCE Respiratory

A 39-year-old man with Crohn's disease is due to start infliximab. He was born in India and has a positive IGRA, normal chest radiograph and no TB symptoms. HIV, hepatitis B and hepatitis C tests are negative. Liver function tests are normal. What is the most appropriate management?

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Correct answer: E — Treat latent TB before anti-TNF therapy

Positive IGRA with no evidence of active disease indicates latent TB infection, which should be treated before anti-TNF therapy. A normal chest radiograph does not negate latent infection. Anti-TNF treatment substantially increases reactivation risk, so screening and prophylaxis are high-yield.

Reference: NICE NG33 Tuberculosis; BTS TB resources