Pulmonary actinomycosis coexisting with intestinal tuberculosis as a complication of adalimumab treatment for Crohn's disease

Tumor necrosis factor alpha (TNF-a) blocking agents are highly effective in inducing and mantaining remission in Crohn's disease (CD) (1). However, due to the profound supression of T-cell mediated immunity, opportunistic infections still remain a major concern in this group of patients (2). We would like to draw attention to the unique case of a young patient with a imunomodulator therapy-resistant Crohn's disease treated with adalimumab who developed pulmonary actinomycosis and intestinal tuberculosis despite adequate screening for latent tuberculosis.