How do you approach a patient on anti-TNF with positive Quantiferon (previously negative) with negative chest x-ray and no symptoms?

Prior to routine screening for latent TB for patients receiving or about to receive TNF inhibitor therapy, there were reports of miliary TB developing after initiation of TNF inhibitors. Therefore, one cannot say that a negative chest x-ray and no symptoms means the patient is not at risk for develo...

IGRAs need to be interpreted in the context of the patient's epidemiologic exposure risks. A patient with low risk for acquiring TB (low prevalence area, no occupational risk, no travel) with a "positive" IGRA is more likely to have a false positive, especially if you have solid evidence that they w...

I stop the TNF and send patient to Infectious disease. After they have treated the patient with Rifampin or INH for a few months, they clear him to resume his TNF.

We routinely check quantiferon prior to initiation of therapies that produce immunosuppression such as chemotherapy.

The answers are correct in leaning towards caution. I want to add a few points:

• Rifampin is safer than INH but it’s not without side effects and significant drug interactions.
• I chec...

Agree with (most) of the prior comments. The higher the titer (if reported), the more likely the QTF is a “true” and opposed to a “false” positive. In addition, we routinely obtain a confirmatory IGRA assay by an alternative method - Quantiferon Gold <-> T-spot.

I’m always more concerned when a prio...

I agree with my colleagues' very helpful suggestions, and (since there aren’t clear guidelines about this, as has been pointed out) find it comforting that most of us err on the side of caution, and employ similar evaluations.

Since we have a close working relationship with our ID colleagues, we typ...

QTB POS. Reasonable to repeat. Asymptomatic with Normal Chest imaging I would defer to ID/Pulmonary but likely, not Rx. However, patients that are to be considered for Biologics/JAKs/High-dose Corticosteroids, no matter the chest imaging, want to see them on LTBI Rx. After 1 month of that Rx, withou...

I would consider this an alarming finding; I would get a non contrast CT chest to see if truly there is no parenchymal findings as the X-Ray is not sufficient to rule that out in this particular scenario; definitely ID consultation to look for extra-pulmonary TB as well.

I agree with a formal ID assessment. I saw a case of a positive Quantiferon-Gold test (and negative chest X-ray) for a patient who had been on years of a TNF-alpha inhibitor that developed probable TB uveitis. When I saw him, he was having issues with his eyes and getting steroid eye drops which wer...

The problem I have is what to do after I treat for LTB, how then to screen for TB given that the TB test will likely always be positive, and as has been mentioned above, a CXR does not rule out TB.

It seems after one treats for LTB, we are in the exact same spot we were in before we treated for LTB,...

Agree with most of what has been said, check history, risk factors, actual numeric values of the test and repeat with same TBGold or do a TB spot. In our state, TB testing before admission to nursing home is somehow become mandatory. I can not find any clinical data to support it (it is based on a "...