In a patient with a positive TB test but a negative chest X-ray, when should immunotherapy be deferred?

In a patient with a positive TB test but a negative chest X-ray, when should immunotherapy be deferred?

• A. Immediately after a positive TB test with negative chest X-ray
• B. 1 month after latent TB treatment initiation
• C. After completion of latent TB treatment
• D. Never defer immunotherapy

Answer: (B)

When a TB screen is positive but the chest X-ray is negative, this points to latent TB infection. Immunotherapy, especially certain biologics used in dermatology, can reactivate latent TB, so you don’t start such therapy right away. The safer approach is to begin latent TB treatment now and defer starting immunotherapy for about one month after LTBI therapy has begun. This window lets the treatment begin to reduce bacterial activity and lowers the risk of reactivation once the immune system is further suppressed by immunotherapy. Continue LTBI treatment during immunosuppression. Deferring immunotherapy until LTBI treatment is underway (roughly one month) balances the need to treat the dermatologic condition with safety around TB reactivation.

When a TB screen is positive but the chest X-ray is negative, this points to latent TB infection. Immunotherapy, especially certain biologics used in dermatology, can reactivate latent TB, so you don’t start such therapy right away. The safer approach is to begin latent TB treatment now and defer starting immunotherapy for about one month after LTBI therapy has begun. This window lets the treatment begin to reduce bacterial activity and lowers the risk of reactivation once the immune system is further suppressed by immunotherapy. Continue LTBI treatment during immunosuppression. Deferring immunotherapy until LTBI treatment is underway (roughly one month) balances the need to treat the dermatologic condition with safety around TB reactivation.