Rituximab for Rheumatoid Arthritis Following TNF-α Inhibitor Associated Splenic Tuberculosis

One of the most important adverse effects of a tumor necrosis factor (TNF)-α inhibitor is the reactivation of tuberculosis. Most of them occur in the lung, but sometimes they can be found in other organs. Moreover, the proper management of active rheumatoid arthritis (RA) in patients with anti-TNF-α associated tuberculosis is still in debate. We present the case of a seropositive RA patient who showed good response with rituximab, an anti-CD20 monoclonal antibody, after developing splenic tuberuculosis, following treatment with TNF-α inhibitor. Confirming a diagnosis of splenic tuberculosis is difficult and can be delayed due to its nonspecific symptoms and rare occurrence. This case suggests that splenic tuberculosis should be doubted in RA patients treated with TNF-α inhibitor, and that rituximab may be considered as an alternative treatment option in RA patients with anti-TNF-α associated tuberculosis.