Editorial
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2024; 12(33): 6604-6607
Published online Nov 26, 2024. doi: 10.12998/wjcc.v12.i33.6604
Early screening to identify and diagnose primary nasal tuberculosis in patients with tumor necrosis factor inhibitors
Dan-Xiang Shen, Yu-Wei Wang, Zhi-Min Lin, Di Jin, Zhen-Hua Ying, Chen Li
Dan-Xiang Shen, Department of Internal Medicine, Changxing Third People's Hospital, Huzhou 313000, Zhejiang Province, China
Dan-Xiang Shen, Zhen-Hua Ying, Department of Rheumatology and Immunology, Jinzhou Medical University Graduate Training Base Zhejiang Provincial People's Hospital, Center for General Practice Medicine, Zhejiang Provincial People's Hospital, Hangzhou 310000, Zhejiang Province, China
Dan-Xiang Shen, Zhen-Hua Ying, Department of Rheumatology, Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine Cultivation for Arthritis Diagnosis and Treatment, Hangzhou 310000, Zhejiang Province, China
Yu-Wei Wang, Department of Cardiology, Yidu Central Hospital of Weifang, Weifang 261000, Shandong Province, China
Zhi-Min Lin, Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing 100020, China
Di Jin, Department of Rheumatology, Weifang People's Hospital, Weifang 261000, Shandong Province, China
Chen Li, Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, Beijing 102400, China
Co-first authors: Dan-Xiang Shen and Yu-Wei Wang.
Co-corresponding authors: Zhen-Hua Ying and Chen Li.
Author contributions: Shen DX, Li C, and Ying ZH conceptualized and designed the research; Shen DX and Wang YW prepared the manuscript and contributed equally to this article, ensuring a cohesive presentation of the research findings; Lin ZM and Jin D were responsible for the meticulous analysis and interpretation of the case, providing essential insights that underpinned the study's conclusions; Li C and Ying ZH, as co-corresponding authors, were at the helm of conceptualizing and designing the research ideas, setting the stage for the study with their innovative and well-defined framework; Li C conceptualized, designed, and supervised the whole process of the project. He searched the literature, revised and submitted the early version of the manuscript. Ying ZH was instrumental and responsible for revision, table plotting, comprehensive literature search, preparation, and submission of the current version of the manuscript. All authors have read and approved the final manuscript, with Shen DX and Wang YW recognized as co-first authors for their significant contributions to the manuscript preparation, and the collaborative efforts of the team were instrumental in bringing the research to fruition.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chen Li, MD, Chief Doctor, Doctor, Staff Physician, Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, No. 151 Chengguan South Street, Fangshan District, Beijing 102400, China. casio1981@163.com
Received: June 4, 2024
Revised: September 17, 2024
Accepted: September 23, 2024
Published online: November 26, 2024
Processing time: 115 Days and 2.2 Hours
Abstract

In this editorial, we comment on the article by Liu et al. Based on our analysis of a case report, we consider that early screening and recognition of primary nasal tuberculosis are crucial for patients undergoing treatment with tumor necrosis factor inhibitor (TNFi). While TNFi therapy increases the risk of reactivating latent tuberculosis, primary nasal tuberculosis remains rare due to the protective mechanisms of the nasal mucosa. Risk factors for primary nasal tuberculosis include minimally invasive nasal surgery, diabetes, and human immunodeficiency virus. Patients with early symptoms such as nasal congestion, rhinorrhea, altered olfaction, epistaxis, or ulceration, and unresponsive to conventional antibiotics and antihistamines should undergo early rhinoscopy, possibly followed by repeated tissue biopsies and acid-fast bacilli culture when necessary. When diagnosis is challenging, it is essential to consider local tuberculosis epidemiology and the efficacy of diagnostic anti-tuberculosis treatment. The preferred method for tuberculosis screening is the Interferon Gamma Release Assay, with a general recommendation for screening at 3 and 6 months after initial treatment and then every six months. However, the optimal frequency is not yet consensus-driven and may be increased in economically viable settings.

Keywords: Tumor necrosis factor inhibitor; Interferon-gamma release assay; Primary nasal tuberculosis; Rhinoscopy; Diabetes mellitus

Core Tip: Patients receiving tumor necrosis factor inhibitor therapy rarely develop primary nasal tuberculosis, with diabetes, human immunodeficiency virus, and minimally invasive nasal surgery being risk factors. Early nasal endoscopy and an appropriately increased frequency of interferon gamma release assay testing may aid in the early screening and identification of nasal tuberculosis.