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...

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.

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 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 interaction...

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.

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 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...