Chest X-ray prior to biological treatment in inflammatory bowel diseases: it is not only about tuberculosis - a case report and literature review
Abstract
Background: Biological treatments have substantially improved management of inflammatory bowel disease, but their profound immunosuppressive effects necessitate infection screening before initiation. Current guidelines recommend chest X-ray (CXR) alongside Mycobacterium tuberculosis testing. While this approach is widely accepted, the necessity of routine CXR in patients without tuberculosis (TB) risk factors has recently been questioned in low-incidence regions.
Methods: We report a rare case of a patient with ulcerative colitis undergoing routine preinfliximab CXR revealing an apical right-lung infiltrate, that was not suspected based on clinical assessment and negative interferon-gamma release assays testing. In addition, we summarize the existing literature on invasive aspergillosis associated with tumor necrosis factor alpha inhibitors.
Results: The patient had minimal clinical symptoms of pulmonary infection and remained afebrile with consistently normal C-reactive protein levels. Nevertheless, routine pretreatment CXR demonstrated an apical right-lung infiltrate, leading to cancelation of planned infliximab initiation. Subsequent analyses of bronchoalveolar fluid and sputum identified two strains of Aspergillus fumigatus . Despite prolonged antifungal therapy, the patient ultimately required a right-lung lobectomy. A comprehensive literature review identified three fatal cases of invasive aspergillosis following tumor necrosis factor alpha inhibitors, underscoring the…
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Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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