CTICasesCavitary Tuberculosis in a Patient on Anti-TNF Therapy
Imaging findings
A 23-year-old man on a TNF-alpha inhibitor for Crohn disease presents with fever and cough and nodular opacities on chest radiograph that partially improve with standard antibacterial treatment, then progress over months to a confluent left lower lobe consolidation and, ultimately, a thick-walled cavity with a fluid level and surrounding nodules. CT shows tiny upper-zone nodules plus clustered airway-centered nodules and peribronchial consolidation surrounding the left lower lobe cavity.
Key takeaways
Progression from nodular consolidation to an atypically low, post-primary cavitary pattern in a patient on anti-TNF therapy -- despite no classic TB risk factors beyond travel to the southern United States -- grew Mycobacterium tuberculosis; TNF-alpha inhibition should prompt consideration of TB even when the imaging pattern and cavity location are atypical for the diagnosis.
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