Pitfalls of a Negative Tuberculin Skin Test When Used as a Screening Modality for Latent Tuberculosis Prior to Adalimumab Therapy: A Case Report

Adalimumab (ADA) is a tumor necrosis factor (TNF) inhibitor commonly used in inflammatory diseases like rheumatoid arthritis and inflammatory bowel disease due to its immunosuppressive effect through TNF alpha blockade.However, this treatment presents with the risk of contracting opportunistic infections like Tuberculosis (TB) that may be missed during initial screening.We discuss a case of an extrapulmonary miliary TB presenting 11 months after starting Adalimumab for treatment of Crohn's disease, despite negative screening with tuberculin skin testing (TST).We discuss the appropriate screening modality to reduce false-negative latent TB screening prior to starting TNF inhibitors for patients diagnosed with Crohn's disease.