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Latent tuberculosis before biologic therapy — SCE Respiratory MCQ

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ModerateRespiratory InfectionsLatent tuberculosis before biologic therapySCE Respiratory

A 41-year-old woman with Crohn's disease is due to start infliximab. She moved from India 5 years ago and is asymptomatic. CXR is normal, HIV test is negative and IGRA is positive. What is the most appropriate management?

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Correct answer: C — Treat latent tuberculosis before starting anti-TNF therapy

Positive IGRA in a high-risk patient before anti-TNF therapy indicates latent TB treatment to reduce reactivation risk. A normal CXR excludes obvious active pulmonary disease but does not exclude latent infection. BCG is not used therapeutically here, and starting anti-TNF without prophylaxis risks disseminated TB.

Reference: NICE NG33; BNF