Inflammatory bowel disease (IBD) is a chronic, inflammatory relapsing and remitting condition of the gastrointestinal tract. It can be divided into two forms Crohn's disease (CD) and ulcerative colitis (UC). The burden of IBD is significantly increased in the past two decades in Asian countries, especially East and South Asian countries, compared to the Western and European countries where the incidence of IBD has plateaued [1]. As per the latest Global tuberculosis (TB) report, most people with TB (44 %) belonged to Southeast Asian countries [2].

Latent TB infection (LTBI) is defined as persistent immune response to stimulation by Mycobacterium tuberculosis antigens without evidence of clinically manifested active TB [3]. TB is endemic in Asian countries and there is a large reservoir of individuals with LTBI [4]. HIV infection, organ transplantation, chronic renal failure requiring dialysis, and the use of immunosuppressant drugs, including biologicals such as anti-tumor necrosis factor (TNF) agents increase risk of development of active TB in patients with latent TB infection [5].

TNF plays an important role in the pathophysiology of IBD by activating intracellular signaling cascades that result in chronic intestinal inflammation [6]. TNF is a key player in governing granulomatous inflammation in TB. These granulomas result in localized inflammation and restrict the pathogen's spread, the absence of which results in disseminated TB [7]. Risk of LTBI reactivation is increased significantly with increasing use of immunosuppressants in IBD. Accordingly, current guidelines recommend screening for LTBI by combining clinical history, chest x-ray, and Tuberculin skin test (TST) or Interferon-gamma release assay (IGRA) or both before starting anti-TNF inhibitors, JAK inhibitors, and sphingosine 1-phosphate receptor modulators in IBD [8], [9]. Japanese guidelines recommend screening with computed tomography (CT) to avoid missing minute lesions on chest X-rays [10]. Indian data on the risk of TB after anti-TNF therapy and its predictors are limited. The present study was undertaken to analyze the characteristics of IBD patients who develop reactivation of TB and its predictors.