رجل عمره ٢٨ سنة بداء كرون، الطبيب يخطط لبدء إنفليكسيماب. سافر قبل سنة لمنطقة فيها سل، ويقول إنه يكح أحياناً. العلامات الحيوية طبيعية. ما الفحص الأهم قبل أول جرعة؟

A 28-year-old with Crohn’s disease is to start infliximab. He travelled to a TB-endemic area a year ago and coughs occasionally. Vitals are normal. Which test matters most before the first dose?

1. An ECG and a full panel of cardiac enzymes
2. A bone density scan to exclude early osteoporosis
3. A bone density scan to exclude early osteoporosis from steroids
4. Latent TB screening (interferon or skin test) and a chest X-ray

Answer: D) Latent TB screening (interferon or skin test) and a chest X-ray. Anti-TNF agents like infliximab reactivate latent TB. Screen for TB before starting, and review vaccinations and hepatitis B status.