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Introduction <p>Tumor necrosis factor-α (TNF-α) inhibitors are first-line agents for steroid-refractory/resistant ulcerative colitis (UC), but their immunosuppressive effect elevates the risk of opportunistic infections, particularly tuberculosis (TB). Extrapulmonary TB such as hepatic and splenic TB is rare but prone to misdiagnosis.</p> Case summary <p>A 55-year-old male was diagnosed with UC in 2003, relieved by sulfasalazine and mesalazine for recurrence in 2021. In 2024, post-perianal abscess surgery, UC relapsed with positive cytomegalovirus (CMV), treated with glucocorticoids and ganciclovir. The patient subsequently developed glucocorticoid-dependent acute severe active UC, presenting with more than 10 bloody stools per day and a Mayo endoscopic score of 3 points. The patient failed to achieve symptom relief after one week of vedolizumab treatment, prompting an immediate adjustment of the therapeutic strategy, and infliximab was therefore initiated. After 6 infliximab doses, he developed fever. T-SPOT/PPD turned positive, with liver and spleen nodules. Biopsy showed epithelioid granulomatous inflammation, Xpert mycobacterium TB/RIF test was positive, leading to hepatic/splenic TB diagnosis. Quadruple anti-TB therapy was initiated. UC relapsed in December 2025, improved by guselkumab. Anti-tuberculosis treatment continues with planned re-evaluation after 1 year.</p> Discussion and literature review <p>Hepatic/splenic TB lacks specificity, often mimicking drug-induced liver injury. Latest guidelines emphasize baseline TB screening (PPD + TSPOT.TB + chest CT) and 3–6 monthly surveillance during biologic use. Anti-TB drugs may exert synergistic anti-UC effects via cytokine inhibition. Extrapulmonary TB requires ≥ 12 months of anti-TB therapy.</p> Conclusion <p>Clinicians should remain alert to hepatic/splenic TB in UC patients receiving biologic therapy, particularly those with sequential biologic exposure. Timely pathological and etiological diagnosis and anti-TB therapy improve prognosis, with strict TB surveillance crucial for early detection.</p>

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Hepatic and splenic tuberculosis following infliximab therapy for refractory ulcerative colitis: a case report and literature review

  • 期刊论文

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  • 发表日期：

    2026年7月16日

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  • Shuo Chen,
  • Yanfen Shi,
  • Yang Pang,
  • Xiaodi Wang,
  • Fang Liu,
  • Shiyu Du

摘要

Introduction

Tumor necrosis factor-α (TNF-α) inhibitors are first-line agents for steroid-refractory/resistant ulcerative colitis (UC), but their immunosuppressive effect elevates the risk of opportunistic infections, particularly tuberculosis (TB). Extrapulmonary TB such as hepatic and splenic TB is rare but prone to misdiagnosis.

Case summary

A 55-year-old male was diagnosed with UC in 2003, relieved by sulfasalazine and mesalazine for recurrence in 2021. In 2024, post-perianal abscess surgery, UC relapsed with positive cytomegalovirus (CMV), treated with glucocorticoids and ganciclovir. The patient subsequently developed glucocorticoid-dependent acute severe active UC, presenting with more than 10 bloody stools per day and a Mayo endoscopic score of 3 points. The patient failed to achieve symptom relief after one week of vedolizumab treatment, prompting an immediate adjustment of the therapeutic strategy, and infliximab was therefore initiated. After 6 infliximab doses, he developed fever. T-SPOT/PPD turned positive, with liver and spleen nodules. Biopsy showed epithelioid granulomatous inflammation, Xpert mycobacterium TB/RIF test was positive, leading to hepatic/splenic TB diagnosis. Quadruple anti-TB therapy was initiated. UC relapsed in December 2025, improved by guselkumab. Anti-tuberculosis treatment continues with planned re-evaluation after 1 year.

Discussion and literature review

Hepatic/splenic TB lacks specificity, often mimicking drug-induced liver injury. Latest guidelines emphasize baseline TB screening (PPD + TSPOT.TB + chest CT) and 3–6 monthly surveillance during biologic use. Anti-TB drugs may exert synergistic anti-UC effects via cytokine inhibition. Extrapulmonary TB requires ≥ 12 months of anti-TB therapy.

Conclusion

Clinicians should remain alert to hepatic/splenic TB in UC patients receiving biologic therapy, particularly those with sequential biologic exposure. Timely pathological and etiological diagnosis and anti-TB therapy improve prognosis, with strict TB surveillance crucial for early detection.