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We illustrate a case of an elderly Indian-born man living in the USA with psoriatic arthritis who was on adalimumab for 10 years. He presented with disseminated TB and herpes simplex virus type 1 (HSV-1) pharyngitis, a year after an innocuous trip to India. Our case draws attention to the adverse effects of biologic drugs and highlights the importance of regular rescreening for a high-risk population. As the use of biologic treatment increases, physicians must be vigilant in more frequent screening, monitoring and identifying related opportunistic infections, notably <jats:italic>M. tuberculosis<\/jats:italic> infections.<\/jats:p>","DOI":"10.1136\/bcr-2018-224459","type":"journal-article","created":{"date-parts":[[2018,10,2]],"date-time":"2018-10-02T09:19:26Z","timestamp":1538471966000},"page":"bcr-2018-224459","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Miliary tuberculosis and herpes pharyngitis after a trip to a developing country: dangers of biologics"],"prefix":"10.1136","volume":"2018","author":[{"given":"Sanket","family":"Patel","sequence":"first","affiliation":[{"name":"Internal Medicine, Cooper University Hospital, Camden, New Jersey, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin Douglas","family":"Weaver","sequence":"additional","affiliation":[{"name":"Internal Medicine, Cooper University Hospital, Camden, New Jersey, USA"},{"name":"Physical Medicine and Rehabilitation, Jackson Memorial Hospital, Miami, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satyajeet","family":"Roy","sequence":"additional","affiliation":[{"name":"Internal Medicine, Cooper University Hospital, Camden, New Jersey, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,10,2]]},"reference":[{"key":"2025082702585604000_2018.oct02_1.bcr-2018-224459.1","unstructured":"Janssenlabels.com, 2017. 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