Late reactivation of spinal tuberculosis by low-dose methotrexate therapy in a patient with rheumatoid arthritis

Abstract

Sir, It is generally accepted that the use of chronic corticosteroid treatment predisposes to primary tuberculosis (TB) and reactivation of TB infection [1], and most of the TB cases reported in rheumatoid arthritis (RA) and other rheumatic diseases are associated with the use of long‐term corticosteroid therapy [2]. A handful of cases of primary TB associated with the use of low‐dose methotrexate (MTX) have been reported in patients with psoriasis [3]. We believe, however, that ours is the first case of TB reactivation associated with low‐dose MTX therapy alone in a patient with RA.