A case report of patient with rheumatoid arthritis who developed tuberculosis of the lung despite negative T-SPOT as pre-initiation screening prior to administrate baricitinib

Abstract

One case with rheumatoid arthritis（RA）who had who developed tuberculosis of the lung despite T-SPOT test as a pre-initiating screening for baricitinib being negative, was observed. He was an 84-year-old male patient. His RA history was 2 years at initial consultation, and simplified disease activity index（SDAI）was 13.0. Treatment was initiated with methotrexate（MTX）at a dosage of 6 mg per week and gradually increased to 12 mg. When MTX dosage tapered due to recognition of renal disorder, his disease activity quickly rose to an SDAI of 36.4. Before initiating baricitinib, preinitiating screening was performed including T-SPOT and confirmed to be negative. His chest CT appeared to show slight interstitial lung change, however he did not complain of cough or sputum. Baricitinib was initiated 4 months after first consultation with a dosage of 4 mg per day, upon which disease activity rapidly settled, and his SDAI went into remission in 6 weeks. Five months later, he complained of general fatigue, while his chest CT revealed lung tuberculosis with Gafky No.5. At this time anti-tuberculosis therapy started. Baricitinib was discontinued thereafter, while predonisolone at a dose of 7.5 mg per day was administrated. His SDAI remained in remission, and there was no discharge of sputum. This case suggested that even though T-SPOT was negative, careful attention should be paid for tuberculosis during concomitant baricitinib administration especially in elderly patients.