Delayed Tuberculosis Paradoxical Reaction Associated with Tumor Necrosis Factor Inhibitors.

This letter discusses the occurrence of tuberculosis (TB) paradoxical reactions (PRs) in patients being treated with tumor necrosis factor (TNF) inhibitors. PRs are defined as the worsening of clinical or radiological findings after the initiation of appropriate antimycobacterial therapy. The authors report 15 cases of PRs in 12 patients, with most reactions occurring long after the completion of TB treatment. The article provides a table detailing the characteristics of these cases. The report emphasizes the need for clinicians to be vigilant for delayed PR presentations in patients who have received TNF inhibitor therapy, as anti-inflammatory therapy may be more important than reintroducing antimicrobial therapy. The report also mentions the increased number of TB cases associated with TNF inhibitor therapy and the potential role of immune abnormalities in PR. [Extracted from the article]