Our main concern regarding the use of TNF-alpha antagonists is a high tuberculosis rate reported in BS patients.25 Moreover, we think thalidomide may be an alternative to TNF-alpha antagonists, because among the 6 azathioprine-resistant patients and 1 infliximab-resistant patient who were prescribed thalidomide, only 1 did not obtain remission and had to switch to infliximab. Here, TNF is linked to Bloom syndrome.