TNF and leprosy: Studies have suggested that the use of anti-TNF may be a risk factor for leprosy or reactivation of subclinical infections, which could possibly be explained by an interference with granuloma formation.52, 53, 54 Literature also cites leishmaniasis, especially visceral cases, as a potential infectious complication of anti-TNF immunosuppression.55, 56 In the absence of specific guidelines, determining appropriate screening and therapeutic strategies can be challenging.