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Myxoedema coma following commencement of anti-TNF therapy and tuberculosis prophylaxis in a patient with RA and latent tuberculosis infection
  1. Ashok Kumar1,
  2. Anunay Agarwal1,
  3. Ashish Sharma1,
  4. Divya Agarwal2,
  5. Nitin Jain3,
  6. Praveen Gupta4
  1. 1 Department of Rheumatology, Fortis FLT LT Rajan Dhall Hospital, New Delhi, India
  2. 2 Department of Rheumatology, Kailash Hospital and Research Centre Limited, Noida, India
  3. 3 Department of Critical Care, Fortis Memorial Research Institute, Gurugram, India
  4. 4 Department of Neurology, Fortis Memorial Research Institute, Gurugram, India
  1. Correspondence to Dr Anunay Agarwal, Rheumatology, Fortis FLT LT Rajan Dhall Hospital, New Delhi, Delhi 110070, India; anunayagarwal{at}

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Case report

A 67-year-old man with an 8-year history of seropositive rheumatoid arthritis (RA) on conventional synthetic disease-modifying antirheumatic drug (csDMARD) and history of hypertension and bilateral total knee replacement done 2 years ago presented with active arthritis. He was advised to switch to a biological DMARD etanercept (tumour necrosis factor inhibitor (TNFi)). For this reason, screening tests for latent tuberculosis, hepatitis B and hepatitis C were performed. His chest X-ray showed a fibrotic lesion in the left upper zone and his Mantoux test was positive. He was commenced on etanercept biosimilar along with rifampicin and isoniazid for latent tuberculosis infection.

Two days after the commencement of this treatment, the patient developed a loss of appetite and somnolence. His condition progressively deteriorated culminating …

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  • Contributors Writing of report: AK and AA. Review of literature: AK and AA, AS. Discussion: AK, AA, AS, DA, NJ and PG.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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