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We read the case-based discussion published in Thorax by Hofland et al1 with great interest. The case studies reported by the authors raise a very important point about the necessity for continued monitoring of patients on tumour necrosis factor (TNF)-α antagonist therapy, even in the absence of evidence of latent TB infection (LTBI) at the onset of therapy and this is a point that is not discussed in the most recent British Thoracic society (BTS) guidance document on TB and anti-TNF α treatment.2
The two cases described in the article would be classified as ‘low risk’ and thus not offered chemoprophylaxis if managed according to current BTS recommendations. …
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