Disseminated tuberculosis despite preventive treatment in patients treated with tumor necrosis factor inhibitors: A report of two cases

Disseminated tuberculosis despite preventive treatment in patients treated with tumor necrosis factor inhibitors: A report of two casesTumor necrosis factor-alpha inhibitors are widely used for autoimmune diseases but are associated with an increased risk of active tuberculosis due to impaired granuloma formation.Despite screening and preventive treatment for Mycobacterium tuberculosis before initiating therapy, risk persists, especially in endemic regions.Herein, it was aimed to report two cases of disseminated tuberculosis in patients treated with tumor necrosis factor-alpha inhibitors, despite completing preventive therapy.The first patient, a 34-yearold male with rheumatoid arthritis, developed miliary tuberculosis one month after starting adalimumab, despite prior isoniazid prophylaxis.The second patient, a 25-year-old female with ulcerative colitis, presented with miliary tuberculosis and elevated liver enzymes after receiving infliximab and completing preventive therapy.Both patients were treated with first-line antituberculosis drugs, showing clinical, radiological, and bacteriological improvement.These cases underscore that immunosuppression caused by infliximab and adalimumab may overcome prophylactic protection, highlighting the need for continuous monitoring as preventive therapy does not guarantee complete protection.