Late and Aggressive Reactivation of Latent Extrapulmonary Tuberculosis Following a Biopsy in a Dermatomyositis Patient

Introduction and importance: Reactivation of latent tuberculosis (TB) decades after primary infection is rare.Certain risk factors for active TB infections and reactivation, such as immunosuppressive agents, are well known and understood, while others, such as the presence of specific rheumatological diseases, are still the focus of research interest.The idiopathic inflammatory myositis (IIM) subgroup is at high risk for TB and appears to be particularly susceptible to extrapulmonary TB (EPTB).Case presentation: We herein report a 74-year-old woman who experienced late and severe reactivation of latent EPTB following a skin biopsy for the further diagnosis of her underlying disease, dermatomyositis, and mycophenolate mofetil and glucocorticoid treatment.Clinical discussion: Immunocompromised patients generally have an increased risk of active TB as well as reactivation of a latent infection.Patients with IIM are at an even higher risk.Rheumatological societies recommend screening for latent TB after a risk evaluation.Conclusion: Our case demonstrates how difficult a risk assessment in certain cases might be and that, for specific subgroups with a high risk for TB and a high proportion of EPTB, screening should be mandatory.Furthermore, if in doubt, prophylactic treatment should be carried out before starting immunomodulatory therapy.