The Crohn's disease perineal treatment is made by the combination of drug and surgery therapy. The biological therapy is important due to clinical efficacy in inducing and maintaining disease remission. However, because of immunomodulating and immunosuppressive effects, the use of biological as infliximab and adalimumab increases the risk of opportunistic infections. We report a case of a 28-year-old, female patient, diagnosed with Crohn's perineal disease, taking azathioprine and adalimumab, complaining of dry cough, evening fever, and dyspnea for seven days. On physical examination, febrile, dehydrated, decreased, breath sounds in the middle and lower fields of the right hemithorax and scar of anorectal fistulotomy without signs of inflammation. The chest radiograph showed pleural effusion in the right hemithorax, and the analysis of pleural fluid found high levels of adenosine deaminase, normal levels of glucose and cytology differential with 88% of mononuclear cells. With the diagnosis of pleural tuberculosis, the patient was treated with triple drug regimen (rifampicin, isoniazid, and pyrazinamide) for six months associated with prednisone 40 mg/day, for one month, with subsequent weaning of corticosteroid. Currently, she is asymptomatic and in treatment with ciprofloxacin 1 g daily for perineal Crohn's disease.
