Abstract
Background: Screening of latent tuberculosis (TB) before the induction of anti-tumor necrosis factor (anti-TNF) agents is very important to prevent the reactivation of TB. However, active TB can still occur, and the ideal therapeutic strategy for IBD patients who develop active TB has not been established. Case presentation: A 21-year-old Vietnamese man with active ileo-colonic Crohn’s disease visited our hospital. While computed tomography (CT) revealed a nodular lesion at the right lung, a serological interferon gamma release assay (IGRA) and several culture tests were all negative. The intravenous administration of infliximab-biosimilar (IFX-BS) with an immunomodulator were initiated. After the induction therapy, he achieved clinical remission. However, he presented with a high fever 17 weeks after the initiation. CT revealed the expansion of the nodular lesion at the right lung, and serological IGRA was positive. He was diagnosed with reactivation of latent TB. He had not achieved mucosal healing when immunosuppressive therapy was discontinued. Thus, he was administered vedolizumab (VDZ), which was considered not to influence the TB status, as maintenance therapy. Consequently, he achieved mucosal healing without relapse of active TB.Conclusions: This is the first report to describe the safe usage of VDZ as maintenance therapy without the induction of TB relapse in a CD patient. In Asian countries, clinicians must be alert for the reactivation of latent TB during the administration of anti-TNF agents. VDZ might be a safe option for maintenance therapy in CD patients, even in cases with active TB.
P148 Role of interferon gamma release assay (IGRA) in differentiating gastrointestinal tuberculosis from Crohn's disease
