Beyond the Flare: A Case of Disseminated Tuberculosis and Thrombosis Masquerading as IBD Exacerbation

Cavalli CAM, Gabbiadini R, Dal Buono A, et al. Lung involvement in inflammatory bowel diseases: shared pathways and unwanted connections. J Clin Med. 2023. https://doi.org/10.3390/jcm12196419.

Article  PubMed  PubMed Central  Google Scholar 

Massart A, Hunt DP. Pulmonary manifestations of inflammatory bowel disease. Am J Med. 2020;133:39–43. https://doi.org/10.1016/j.amjmed.2019.07.007.

Article  PubMed  Google Scholar 

Lu DG, Ji XQ, Liu X, et al. Pulmonary manifestations of Crohn’s disease. World J Gastroenterol. 2014;20:133–41. https://doi.org/10.3748/wjg.v20.i1.133.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Preotesoiu I, Alexandrescu L, Cimpineanu B, et al. From gut to lungs: the hidden respiratory impacts of IBD: a systematic review of the literature. Int J Mol Sci. 2025. https://doi.org/10.3390/ijms26188912.

Article  PubMed  PubMed Central  Google Scholar 

Gordon H, Burisch J, Ellul P, et al. ECCO guidelines on extraintestinal manifestations in inflammatory bowel disease. J Crohns Colitis. 2024;18:1–37. https://doi.org/10.1093/ecco-jcc/jjad108.

Article  PubMed  Google Scholar 

Ford AC, Peyrin-Biroulet L. Opportunistic infections with anti-tumor necrosis factor-α therapy in inflammatory bowel disease: meta-analysis of randomized controlled trials. Am J Gastroenterol. 2013;108:1268–76. https://doi.org/10.1038/ajg.2013.138.

Article  CAS  PubMed  Google Scholar 

Zhang Z, Fan W, Yang G, et al. Risk of tuberculosis in patients treated with TNF-α antagonists: a systematic review and meta-analysis of randomised controlled trials. BMJ Open. 2017;7:12567. https://doi.org/10.1136/bmjopen-2016.

Article  Google Scholar 

Cao BL, Qasem A, Sharp RC, et al. Systematic review and meta-analysis on the association of tuberculosis in Crohn’s disease patients treated with tumor necrosis factor-α inhibitors (Anti-TNFα). World J Gastroenterol. 2018;24:2764–75. https://doi.org/10.3748/wjg.v24.i25.2764.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Riestra S, Taxonera C, Zabana Y, et al. Recommendations of the Spanish Working Group on Crohn’s Disease and Ulcerative Colitis (GETECCU) on screening and treatment of tuberculosis infection in patients with inflammatory bowel disease. Gastroenterol Hepatol. 2021;44:51–66. https://doi.org/10.1016/j.gastrohep.2020.04.006.

Article  PubMed  Google Scholar 

Feakins R, Torres J, Borralho-Nunes P, et al. ECCO topical review on clinicopathological spectrum and differential diagnosis of inflammatory bowel disease. J Crohns Colitis. 2022;16:343–68. https://doi.org/10.1093/ecco-jcc/jjab141.

Article  PubMed  Google Scholar 

Gecse KB, Vermeire S. Review Differential diagnosis of inflammatory bowel disease: imitations and complications. vol. 3. 2018.

Lawrance IC, Radford-Smith GL, Bampton PA, et al. Serious infections in patients with inflammatory bowel disease receiving anti-tumor-necrosis-factor-alpha therapy: an Australian and New Zealand experience. J Gastroenterol Hepatol (Australia). 2010;25:1732–8. https://doi.org/10.1111/j.1440-1746.2010.06407.x.

Article  Google Scholar 

Kedia S, Mouli VP, Kamat N, et al. Risk of tuberculosis in patients with inflammatory bowel disease on Infliximab or Adalimumab is dependent on the local disease burden of tuberculosis: a systematic review and meta-analysis. Am J Gastroenterol. 2020;115:340–9. https://doi.org/10.14309/ajg.0000000000000527.

Article  PubMed  Google Scholar 

Gómez-Reino JJ, Carmona L, Rodríguez Valverde V, et al. Treatment of rheumatoid arthritis with tumor necrosis factor inhibitors may predispose to significant increase in tuberculosis risk: a multicenter active-surveillance report. Arthritis Rheum. 2003;48:2122–7. https://doi.org/10.1002/art.11137.

Article  CAS  PubMed  Google Scholar 

Thomas K, Hadziyannis E, Hatzara C, et al. Conversion and reversion rates of tuberculosis screening assays in patients with rheumatic diseases and negative baseline screening under long-term biologic treatment. Pathog Immun. 2020;5:34–51. https://doi.org/10.20411/pai.v5i1.349.

Article  PubMed  PubMed Central  Google Scholar 

Pattanaik D, Gupta S, Islam S, et al. Conversion of tuberculosis screening tests during biologic therapy among veteran patient population with rheumatic disease. ACR Open Rheumatol. 2019;1:542–5. https://doi.org/10.1002/acr2.11070.

Article  PubMed  PubMed Central  Google Scholar 

Zabana Y, Domènech E, López San Román A, et al. Tuberculous chemoprophylaxis requirements and safety in inflammatory bowel disease patients prior to anti-TNF therapy. Inflamm Bowel Dis. 2008;14:1387–91. https://doi.org/10.1002/ibd.20496.

Article  PubMed  Google Scholar 

Mañosa M, Domènech E, Cabré E. Current incidence of active tuberculosis in IBD patients treated with anti-TNF agents: still room for improvement. J Crohns Colitis. 2013. https://doi.org/10.1016/j.crohns.2013.04.021.

Article  PubMed  Google Scholar 

Park DI, Hisamatsu T, Chen M, et al. Asian Organization for Crohn’s and Colitis and Asia Pacific Association of Gastroenterology consensus on tuberculosis infection in patients with inflammatory bowel disease receiving anti-tumor necrosis factor treatment. Part 2: management. Intest Res. 2018;16:17. https://doi.org/10.5217/ir.2018.16.1.17.

Article  PubMed  PubMed Central  Google Scholar 

Taxonera C, Ponferrada Á, Riestra S, et al. Serial tuberculin skin tests improve the detection of latent tuberculosis infection in patients with inflammatory bowel disease. J Crohns Colitis. 2018;12:1270–9. https://doi.org/10.1093/ecco-jcc/jjy104.

Article  PubMed  Google Scholar 

Lee JW, Choi CH, Park JH, et al. Clinical features of active tuberculosis that developed during anti-tumor necrosis factor therapy in patients with inflammatory bowel disease. Intest Res. 2016;14:146–51. https://doi.org/10.5217/ir.2016.14.2.146.

Article  PubMed  PubMed Central  Google Scholar 

Lin Z, Bai Y, Zheng P. Meta-analysis: efficacy and safety of combination therapy of infliximab and immunosuppressives for Crohn’s disease. Eur J Gastroenterol Hepatol. 2011;23:1100–10. https://doi.org/10.1097/MEG.0b013e32834b9544.

Article  CAS  PubMed  Google Scholar 

Debeuckelaere C, De M, Van PB, et al. Tuberculosis infection following anti-TNF therapy in inflammatory bowel disease, despite negative screening. J Crohns Colitis. 2014;8:550–7. https://doi.org/10.1016/j.crohns.2013.11.008.

Article  PubMed  Google Scholar 

Çekiç C, Aslan F, Vatansever S, et al. Latent tuberculosis screening tests and active tuberculosis infection rates in Turkish inflammatory bowel disease patients under anti-tumor necrosis factor therapy. Ann Gastroenterol. 2015;28:241–6.

PubMed  PubMed Central  Google Scholar 

Kim MJ, Kim YJ, Jeong D, et al. Comparative risk of serious infections and tuberculosis in Korean patients with inflammatory bowel disease treated with non-anti-TNF biologics or anti-TNF-α agents: a nationwide population-based cohort study. Therap Adv Gastroenterol. 2024. https://doi.org/10.1177/17562848241265013.

Article  PubMed  PubMed Central  Google Scholar 

Kim ES, Song GA, Cho KB, et al. Significant risk and associated factors of active tuberculosis infection in Korean patients with inflammatory bowel disease using anti-TNF agents. World J Gastroenterol. 2015;21:3308–16. https://doi.org/10.3748/wjg.v21.i11.3308.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Kumar P, Vuyyuru SK, Kante B, et al. Efficacy and safety of biosimilar versus originator infliximab in patients with inflammatory bowel disease: a real-world cohort analysis. Indian J Gastroenterol. 2022;41:446–55. https://doi.org/10.1007/s12664-022-01252-5.

Article  PubMed  Google Scholar 

Jauregui-Amezaga A, Turon F, Ordás I, et al. Risk of developing tuberculosis under anti-TNF treatment despite latent infection screening. J Crohns Colitis. 2013;7:208–12. https://doi.org/10.1016/j.crohns.2012.05.012.

Article  PubMed  Google Scholar 

Hong SN, Kim HJ, Kim KH, et al. Risk of incident Mycobacterium tuberculosis infection in patients with inflammatory bowel disease: a nationwide population-based study in South Korea. Aliment Pharmacol Ther. 2017;45:253–63. https://doi.org/10.1111/apt.13851.

Article  CAS  PubMed  Google Scholar 

Oseph Eane JK, Haron Ershon SG, Harm PD, et al. The New Eng land Jour nal of Medicine tuberculosis associated with infliximab, a tumor necrosis factor a-neutralizing agent abstract. vol. 345. 2001.

Abreu C, Magro F, Santos-Antunes J, et al. Tuberculosis in anti-TNF-α treated patients remains a problem in countries with an intermediate incidence: analysis of 25 patients matched with a control population. J Crohns Colitis. 2013. https://doi.org/10.1016/j.crohns.2013.03.004.

Article 

Comments (0)

No login
gif