LAUSR

tion. If TB is diagnosed during the use of a biological, it must be discontinued immediately, and anti-TB therapy should be initiated. It is safe to restart the biological after successful completion of treatment. However, if psoriasis is severe, an IL-23 inhibitor can be started (along with TB treatment) after 2 months of therapy, as long as TB is improving and is not severe, as in this case. Indeed, while disseminated TB is fairly common in patients receiving TNF-a inhibitors, in this first case of ATBI during an anti-IL-23 antibody the presentation was quite different, with a cavitary pulmonary TB. It may be advantageous to choose an IL-17 or IL-23 inhibitor for the treatment of psoriasis in regions where TB is endemic or in high-risk populations. Nevertheless, our case reinforces that screening for TB before and during biological therapy should continue regardless of biological class, especially in countries with a high prevalence of this infection.