众所周知，肿瘤坏死因子抑制剂 (TNFi) 会增加结核病 (TB) 再激活的风险，但涉及牛分枝杆菌的病例很少报道。我们描述了一名 78 岁女性患有牛分枝杆菌播散性结核病的病例，该女性患有干扰素γ释放试验（IGRA）呈阴性，因类风湿性多关节炎而服用阿达木单抗，导致致命结果。非典型的临床和组织病理学特征最初被解释为结节病。该病例发生在瑞士，该国是一个正式无牛结核病的国家。患者培养的牛支原体分离株的全基因组序列被鉴定属于动物谱系La1.2，这是欧洲大陆的主要基因型，但与之前测序的瑞士牛品系显示出显着的遗传距离。在文献综述中，发现了 4 例在 TNFi 治疗下牛结核病再激活的病例，有肺部、口腔和肠道表现。与我们的患者类似，有两个病例在 TNFi 开始前呈阴性 IGRA，后来在出现牛分枝杆菌感染症状时转为阳性。该病例强调了免疫抑制患者中结核病诊断的挑战、IGRA 的有限敏感性以及重要性即使在宣布无牛结核病的地区也考虑结核病重新激活。详细的患者病史，包括可能接触未经高温消毒的乳制品，对于在 TNFi 开始之前指导预防性结核病治疗至关重要。© 2024。作者。

Tumor necrosis factor inhibitors (TNFi) are known to increase the risk of tuberculosis (TB) reactivation, though cases involving Mycobacterium bovis are rarely reported.We describe a case of disseminated TB with M. bovis in a 78-year-old woman with a negative Interferon-Gamma-Release Assay (IGRA), taking adalimumab due to rheumatoid polyarthritis, which resulted in a fatal outcome. The atypical clinical and histopathological features were initially interpreted as sarcoidosis. The case occurred in Switzerland, an officially bovine tuberculosis-free country. The whole genome sequence of the patient's cultured M. bovis isolate was identified as belonging to the animal lineage La1.2, the main genotype in continental Europe, but showed significant genetic distance from previously sequenced Swiss cattle strains. In a literature review, four cases of bovine tuberculosis reactivation under TNFi treatment were identified, with pulmonal, oral and intestinal manifestations. Similar to our patient, two cases presented a negative IGRA before TNFi initiation, which later converted to positive upon symptomatic presentation of M. bovis infection.This case highlights the diagnostic challenges of TB in immunosuppressed patients, the limited sensitivity of IGRA, and the importance of considering TB reactivation even in regions declared free of bovine tuberculosis. Detailed patient histories, including potential exposure to unpasteurized dairy products, are essential for guiding preventive TB treatment before TNFi initiation.© 2024. The Author(s).