Guney-Coskun M, Basaranoglu M. Pulmonary tuberculosis and nutritional vulnerability during anti-tumor necrosis factor therapy for inflammatory bowel disease: Two case reports. World J Clin Cases 2026; 14(17): 120718 [DOI: 10.12998/wjcc.v14.i17.120718]
Corresponding Author of This Article
Merve Guney-Coskun, PhD, Lecturer, Department of Nutrition and Dietetics, Istanbul Medipol University, School of Health Sciences, Kavacık, Göztepe Mah, Atatürk Cd. No. 40, Istanbul 34810, Beykoz, Türkiye. merve.guney@medipol.edu.tr
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Gastroenterology & Hepatology
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case-report
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Guney-Coskun M, Basaranoglu M. Pulmonary tuberculosis and nutritional vulnerability during anti-tumor necrosis factor therapy for inflammatory bowel disease: Two case reports. World J Clin Cases 2026; 14(17): 120718 [DOI: 10.12998/wjcc.v14.i17.120718]
World J Clin Cases. Jun 16, 2026; 14(17): 120718 Published online Jun 16, 2026. doi: 10.12998/wjcc.v14.i17.120718
Pulmonary tuberculosis and nutritional vulnerability during anti-tumor necrosis factor therapy for inflammatory bowel disease: Two case reports
Merve Guney-Coskun, Metin Basaranoglu
Merve Guney-Coskun, Department of Nutrition and Dietetics, Istanbul Medipol University, School of Health Sciences, Istanbul 34810, Beykoz, Türkiye
Metin Basaranoglu, Department of Gastroenterology, Bezmialem Vakif University Faculty of Medicine, Istanbul 34093, Türkiye
Author contributions: Guney-Coskun M and Basaranoglu M contributed to manuscript writing and editing; Guney-Coskun M contributed to nutrient intake analysis; Basaranoglu M contributed to conceptualization and supervision; and all authors have read and approved the final manuscript.
AI contribution statement: AI-based language tools were used only for language editing and writing assistance to improve clarity and readability. All scientific content, clinical interpretation, case data, and conclusions were developed, reviewed, and approved entirely by the authors. No AI-generated images or data were used in this manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Merve Guney-Coskun, PhD, Lecturer, Department of Nutrition and Dietetics, Istanbul Medipol University, School of Health Sciences, Kavacık, Göztepe Mah, Atatürk Cd. No. 40, Istanbul 34810, Beykoz, Türkiye. merve.guney@medipol.edu.tr
Received: March 9, 2026 Revised: April 19, 2026 Accepted: May 7, 2026 Published online: June 16, 2026 Processing time: 88 Days and 17.2 Hours
Abstract
BACKGROUND
Tumor necrosis factor (TNF) inhibitors are effective in the treatment of inflammatory bowel disease (IBD) but increase tuberculosis (TB) risk. Standard latent TB infection screening before biologic therapy does not fully eliminate this risk. We report two cases of active pulmonary TB developing despite negative baseline screening, highlighting nutritional vulnerability and crowded living environments as underrecognized contributing factors. This report uniquely combines nutritional assessment data with environmental context to provide a more comprehensive perspective on TB risk in patients receiving biologic therapy.
CASE SUMMARY
Two young female university students with IBD developed active pulmonary TB within six months of initiating anti-TNF therapy despite negative baseline screening using tuberculin skin test, interferon-gamma release assay, and chest radiography. Both patients resided in crowded university dormitories. Nutritional assessment by a registered dietitian using 24-hour dietary recall revealed inadequate dietary intake with low energy, protein, fiber, iron, calcium, and vitamin B12 levels in both cases. Anti-TNF therapy was discontinued, and anti-TB treatment was initiated, leading to clinical improvement in both patients. Both patients achieved clinical improvement; Case 1 completed treatment with confirmed mucosal remission, while Case 2 remains under follow-up.
CONCLUSION
TB prevention in biologic-treated inflammatory bowel disease should incorporate nutritional assessment and environmental risk evaluation alongside standard screening.
Core Tip: Standard latent tuberculosis (TB) infection screening before anti-tumor necrosis factor therapy does not fully protect against active TB in patients with inflammatory bowel disease (IBD). This report is the first to systematically document both nutritional deficiency and crowded dormitory exposure as concurrent, potentially modifiable risk factors in this setting. Clinicians managing IBD with biologic therapy should integrate routine nutritional assessment and environmental risk evaluation into their preventive approach, particularly for young patients in communal living settings. These findings support expanding TB prevention beyond serology to a multifactorial clinical framework.
