Tuberculosis is described during the use of monoclonal antibodies against tumour necrosis factor (TNF) for Crohn’s disease treatment. We report a case of a 44 year old man that developed fever, night sweats and weight loss during immunosuppressive and anti-TNF therapy for Crohn’s disease. After extensive investigation we performed mediastinoscopy with biopsy of the paratracheal lymph node. A istopathological study revealed caseous necrosis. The patient improved after therapy against tuberculosis. During anti-TNF therapy, the diagnosis of tuberculosis may be mainly difficult when an atypical location is present. Clinical skills are important mainly in countries where tuberculosis is endemic.

The current therapeutic goal in the management of chronic hepatitis B (CHB) infection is to persistently suppress hepatitis B virus (HBV) replication and prevent its progression to liver failure and the development of hepatocellular carcinoma (HCC). At present, the therapeutic strategies for CHB includes either a short course of pegylated-interferon-alfa (PEG-IFNa) and/or a long term course of nucleos(t)ide analogues (NA’s). NA’s are more preferable to PEG-IFNa, majorly for its easier route of administration and excellent tolerance and safety profiles. Entecavir (ETV) and tenofovir (TDF) are the current first line options for its potency to maintain sustained virological response (SVR) in almost 100% of the adherent individuals along with minimal to no long-term resistance. These sustained inhibitions of HBV replication have been shown to be associated with histological improvement, modifying the long-term outcomes. However, HBsAg seroconversion, the best surrogate marker for viral clearance is still unachievable with the current first line agents and hence the risk for hepatocellular carcinoma (HCC) still exists among them. This makes us to still consider, a finite duration of PEG-IFNa that has shown considerable results with regards to HBsAg loss, as an attractive add-on or monotherapy option despite its adverse events profile. Existing evidences do not recommends its usage. However, numerous studies are ongoing and also further studies to evaluate the reliable baseline predictors of response to PEG-IFNa and early on-treatment stopping rules based on age, alanine aminotransferase levels (ALT), HBV DNA levels and HBsAg kinetics would be ideal.

One of the most important events on gastroenterology certainly was the isolation of Helicobacter pylori (H. pylori) by Barry Marshall and Robin Warren in 1983 [1], occurrence which redirected our understanding of the pathophysiology of gastrointestinal diseases. The production of urease as well as the mobility of these bacteria promoted by flagella were identified as essential factors for colonization of the gastric epithelium and, from there, within a few years, the list of H. pylori virulence factors for colonizing and persisting on the gastric surface epithelium besides some factors damaging the mucosa expanded greatly.