A 74-year-old female was suffering from RA since 1993. The patient had received treatment with various DMARDs such as methotrexate (MTX), salazosulfapyridine (SASP), gold sodium thiomalate, and bucillamine (BUC). However, the administration of these agents was discontinued due to treatment-related adverse events or insufficient efficacy. In March 2009, adalimumab (ADA) (40 mg every 2 weeks) was added to low-dose prednisolone (PSL). The patient initiated prophylactic therapy with isonicotinic acid hydrazide (INH) for 6 months targeting recurrence of old pulmonary TB. A tuberculin skin test (TST) (positive) was performed prior to initiation of treatment with ADA. However, in August 2009, ADA was switched to etanercept (ETN) due to secondary failure to ADA. In October 2009, the patient was admitted to the National Sagamihara Hospital with infectious arthritis of knee or ankle caused by methicillin-resistant Staphylococcus aureus (MRSA). In April 2010, intravenous administration of vancomycin or teicoplanin (TEIC) improved the aforementioned symptoms (Figure 1). RA disease activity was low with PSL 10 mg/day and SASP 1 g/day without ETN. In May 2010, the patient presented with urinary tract infection (UTI) caused by Escherichia coli with an observed increase in the levels of neutrophil CD64. Neutrophil surface CD64 expression was measured using QuantiBRITE CD64 PE/CD45 PerCP (Becton Dickinson, San Jose, CA) and a FACSCalibur flow cytometer (Becton Dickinson) as previously described. The UTI improved following appropriate treatment for pathogenic bacteria. However, the levels of neutrophil CD64 continued to increase reaching >10,000 molecules/cell in June 2010. Subsequently, the patient had fever with bilateral infiltrative shadows appearing on a chest X-ray and positive MRSA sputum culture. TEIC was administered intravenously and the patient's temperature returned to normal, with a decrease in the levels of serum C-reactive protein (CRP). However, the levels of neutrophil CD64 increased up to 17,509 molecules/cell, and newly developed diffuse reticulonodular shadows were observed in both lung fields using a chest X-ray. Whole-body computed tomography (CT) revealed diffuse small granular shadows on both lungs and fluid accumulations (abscess) around the lumbar vertebrae Figures 2 and 2. TST was negative, and the smears of sputum and gastric juice were negative for acid-fast bacilli. However, the smear of specimens obtained from the abscess by echo-guided percutaneous drainage contained acid-fast bacilli identified as Mycobacterium tuberculosis by polymerase chain reaction (PCR). The patient was diagnosed with miliary TB along with tuberculous spondylitis and transferred to a hospital which had a TB ward. In September 2010, after treatment for TB, the levels of neutrophil CD64 decreased below the cutoff value (<2000 molecules/cell) and abnormal findings on the CT scan disappeared Figures 2 and 2. Sustained high levels of neutrophil CD64 were considered to be due to reactivation of LTBI.