The absence of fulminant hepatitis or fatal hepatic failure in this anti-TNF cohort contrasts with other studies [13, 18, 23–27]; among 25 published reports of HBsAg+ rheumatic disease patients who received anti-TNF therapy without antiviral prophylaxis, 13 (52%) had HBV reactivations, leading to three cases of fulminant hepatitis, a liver transplant, and one death [26]. Here, TNF is linked to Fulminant hepatitis.