Cerebral tuberculoma in a patient receiving anti-TNF alpha (adalimumab) treatment.
We report a case of a cerebral tuberculoma in a 60-year-old woman with rheumatoid arthritis while receiving the anti-tumor necrosis factor alpha monoclonal antibody, adalimumab (Humira), for active disease. MR brain imaging for dyspraxia revealed a left parietal ring-enhancing lesion, which on resection was shown to be a necrotizing granuloma. There were no associated pulmonary lesions, and the patient was systemically well. Sputum and urine cultures were negative for tuberculosis. The patient was treated with anti-tuberculous medications and made an excellent recovery. We consider this to be the first documented case of tuberculosis involving the central nervous system occurring in the setting of adalimumab treatment.
Lynch
Karen
K
Department of Neuropathology, Beaumont Hospital, Beaumont, Dublin 9, Ireland. karenlynch81@gmail.com
Farrell
Michael
M
D000068879:Adalimumab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000473:pathology / Q000628:therapy*; D001927:Brain Diseases / Q000150:complications* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D010296:Parietal Lobe / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome; D016862:Tuberculoma, Intracranial / Q000150:complications* / Q000473:pathology / Q000601:surgery
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D000068879:Adalimumab