TNF and inflammatory bowel disease: Immunosuppressed patients have a high likelihood of progression to active MtB, warranting routine screening.6,7 Biologic therapies, notably anti-TNF agents, have been associated with a 14-fold increase in TB reactivation compared to healthy controls due to impaired granuloma formation.8,9 Guidelines from gastrointestinal societies and the FDA (United States Food and Drug Administration) recommend screening for LTBI in all patients with IBD planning to initiate treatment with anti-TNF therapy, IL12/23 (Ustekinumab), or α4β7 (Vedolizumab).10–13