Please see below. This is a case that Maryland is brainstorming on to get feedback from others that may have had a similar experience. Can we put this out to the members for discussion.

Good Morning Patty,

I hope all is well in New Jersey!

Maryland has a puzzling TB case and we are looking for advice for patients who have been on Remicade prior to beginning TB treatment.

In August 2016 the case started out as pansensitive miliary TB. The hospital sent a lymph sample which has come back TB+ resistant to RIF. We are brainstorming to try and find issues that may have contributed to the poor outcomes this case is experiencing.

The case was on biweekly Remicade for Crohns which was d/c'd in August upon starting RIPE.

The case then received 8 weeks of RIPE. Do you know of any studies or recommendations that suggest that RIPE should be continued for longer than 8 weeks for patients who recently took Remicade prior to beginning TB treatment?

Any and all guidance you can offer is greatly appreciated!

Cherie Helfrich, MSN, RN

Nurse Consultant

TB Control and Prevention

Infectious Disease Bureau
Prevention and Health Promotion Administration
Maryland Department of Health and Mental Hygiene

500 N. Calvert Street, 5th Fl.

Baltimore MD 21202

(email) cherie.helfrich@maryland.gov

(office) 410-767-6983

(fax) 410-383-1762