Oral tuberculosis in a patient with Crohn's disease on TNFα-blockers.

Reynaert, V; Grosber, M; Tache, A; Mana, F; Buydens, P; Lacor, P; Gutermuth, J

Patients treated with TNFα blockers have an increased risk of reactivating latent tuberculosis (TB). Guidelines therefore recommend chest X-ray and a Tuberculin skin test (TST) or Interferon Gamma Release Assay (IGRA) prior to starting TNFα-blockers. In 2019, a 58-year-old North African female presented with painful oral lesions since two months. This was accompanied by weight loss and intermittent diarrhoea. She had a history of severe Crohn's disease and was treated with Adalimumab since ten years. Initially, the oral lesions were presumed to be part of an inadequately treated Crohn's disease and Adalimumab was exchanged for Ustekinumab. Since the lack of improvement, the patient was hospitalized. Physical examination showed aphthous ulcerations on the upper gingiva (Fig. 1) and a firm nodule on the right buccal mucosa (Fig. 2). Blood analysis was negative for inflammatory parameters and a cranial CT scan demonstrated inflammation without abscesses.