Early screening to identify and diagnose primary nasal tuberculosis in patients with tumor necrosis factor inhibitors

Table 1 Key characteristics of primary nasal tuberculosis induced by tumor necrosis factor inhibitor

Symptoms	Risk factors	Epidemiology	Types of TNFi	Treatment	IGRA	Nasal biopsy	Tissue culture
Nasal congestion; Rhinorrhea; altered olfaction; Epistaxis; Ulcers, etc.	Diabetes; HIV; Minimally invasive nasal surgery	High tuberculosis prevalence areas	Adalimumab and infliximab increase TB risk 3-4 times more than etanercept	Ineffective conventional antibiotics and antihistamines; diagnostic anti-tuberculosis effective	Negative to positive	Granulomatous inflammation with or without caseous changes	Positive for Mtb

TNFi: Tumor necrosis factor inhibitor; HIV: Human immunodeficiency virus; IGRA: Interferon gamma release assay.