All of us have heard, I'm sure, that enbrel and other tnf-inhibitors can reactivate latent tb infections (old infections that were never treated for whatever reason). it may have happened to me. Some of you may recall that I had some sort of weird lung infection this past summer when I first tried mtx. Got a complete work-up with a pulmonologist and everything. An HRCT scan showed scarring and fibrosis consistent with an old tb infection, but I've never been diagnosed or treated for tb. I remember pulmonologist asking me a couple of times if I had ever had tb? Now where on earth would I have been exposed to tb? Nothing was done about it at the time. Fast forward to the present. I've been seeing an infectious disease doctor for these low grade fevers I keep getting. She read my old ct scan, said it looked highly suspicious for an old tb, and that enbrel could have reactivated it which is what is causing my low grade fevers. She has ordered another PPD test with control, but said it will most likely be negative. It's a very gross measurement at best, and immunosupressant drugs will mask a positive. She also ordered another HRCT scan with contrast (didn't have contrast before) to compare to the one I had last October.
Now, I've been scratching my head trying to figure out where on earth I picked up tb? I grew up in middle-class suburban america, although I did live a while in Spain as a kid. After thinking about it, I realized that I probably have been exposed to tb. When I was a graduate student, I took about a year off and worked for a research facility that conducted clinical trials research on drug rehab. I worked in a rehab clinic with IV drug users (heroin). Much of my "glamorous" job entailed doing breathalyzers on the clients. I was trained to always point the little tube away from my face, but these people had all kinds of icky things. I would not be surprised if one or more of them had tb. I know several of them died of AIDS while I was there. Also, during that year the primate lab at that facility had an actual tb scare. I didn't work with animals, and actually had never even visited the primate lab. However, when one of the monkeys came down with tb and gave it to an animal care worker, the entire building (including myself) was forced to do a PPD test. I remember there was quite a hullaballoo about it because many of our scientists were from other countries, and tested positive on the PPD, but did not have tb. I, of course, tested negative. I suppose it is possible that I picked it up there, but didn't get terribly sick with and never went to a doctor for it. I was a heavy smoker at the time, and sported a nasty little smoker's hack. Could have mistaken tb symptoms for that?
In any case, just thought I would share my experience with those of you taking the tnf-inhibitors. Everyone should start demanding a chest x-ray in addition to a PPD test prior to starting these drugs. I'll let everyone know how it all turns out. Jeez, just when my arthritis is going into remission, this stupid thing has to come up. If I have to be treated for tb, I have to come off all of the immunosupressant drugs.
Interesting Keah. Nothing, except the nonspecific finding of peribronchial cuffing, ever showed up on my CXR. But the ct scan I had done last October showed apical scarring, with the peribronchial cuffing--ID doc says that the scarring is typical of an old tb infection. Pulmonologist I went to last October said it was typical of an old infection, but he didn't specify tb. I just completed another ct scan this morning with contrast (I had it without contrast last October). Hopefully, this one will give us something more to go on.