Disseminated Primary Mycobacterium bovis Infection in Patient Receiving Adalimumab Therapy: A Case Report.

Anti-TNF-α therapies are associated with an increased risk of tuberculosis, mainly via the reactivation of latent Mycobacterium tuberculosis. Primary zoonotic Mycobacterium bovis infection is rare and diagnostically challenging, particularly in immunosuppressed patients. We report a case of disseminated Mycobacterium bovis infection in a man receiving long-term adalimumab for psoriasis, complicated by diagnostic delay, suspected hemophagocytic lymphohistiocytosis, and immune reconstitution inflammatory syndrome (IRIS), resulting in a challenging treatment course. Epidemiological history revealed recent travel to Turkey and ingestion of unpasteurized dairy products. This case highlights the need for ongoing exposure assessment, sustained clinical awareness, and individualized therapeutic strategies throughout immunomodulatory treatment.