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Thrombotic thrombocytopenic purpura with the use of efalizumab for psoriasis

by M. tuberculosis but are absent from BCG vaccine strains and from most nontuberculous mycobacteria. There is no crossreactivity in previously vaccinated patients. The test is reported to have greater sensitivity and specificity than Mantoux testing (QFG-T: 89% and 98Æ1%; Mantoux: 72% and 82%). We performed a pilot study of 11 patients (age range 27– 56 years, eight male, three female,) with moderate to severe chronic plaque psoriasis who qualified for anti-TNF-a therapy in accordance with NICE guidance. All patients were of white ethnicity. The QuantiFERON -TB Gold test was performed and compared to Mantoux testing (Table 1). Eight QFT-G tests were negative; three were indeterminate, none were positive. Of the negative tests, all had negative Mantoux tests except one male patient with a Mantoux test of 20 mm diameter. He had been previously vaccinated with BCG but had no risk factors for exposure. Tuberculosis chemoprophylaxis was avoided on the basis of his negative QFT-G. The cost of each test was £58. This compares with the projected cost of unnecessary chemoprophylaxis for 2 months of approximately £750. This feasibility study confirms that the QuantiFERON -TB Gold test is useful for tuberculosis screening prior to antiTNF-a therapy, potentially saving patients from unnecessary chemoprophylaxis. There are direct cost saving implications of the test and indirect savings through a reduction in multiple hospital visits required for the Mantoux method. The QuantiFERON -TB Gold test is currently licensed in the United States for screening for tuberculosis. Its use as a screening tool for anti-TNFa therapy is documented in rheumatology patients; routine use in U.K. tuberculosis screening remains under evaluation. We believe this novel assay should replace traditional Mantoux testing when screening patients for anti-TNF-a therapy.