Before staing Infliximab in a 65-year-old gentleman for Inflammatory bowel disease, following test is done: (A) Colonoscopy, (B) Mantoux test, (C) ERCP, (D) Liver biopsy
Answer is B. Anti-TNF drugs (infliximab, adalimumab) are associated with an increased risk of infections, paicularly reactivation of latent tuberculosis and oppounistic fungal infections including disseminated histoplasmosis and coccidioidomycosis. It is recommended that patients have a purified protein derivative (PPD) or a QuantiFERON-TB gold test as well as a chest x-ray before initiation of anti-TNF therapy. Patients over 65 have a higher rate of infections and death on infliximab or adalimumab than those younger than 65 years of age.Ref: Harrison's 19e p1962