Fatal varicella-zoster virus vasculopathy associated with adalimumab therapy.
OBJECTIVE
To describe the case of a patient who had been receiving adalimumab for rheumatoid arthritis and died of varicella-zoster virus vasculopathy with multifocal cerebral hemorrhage.


METHODS
Case report.


METHODS
Hanyang University Hospital, Seoul, Republic of Korea.


METHODS
A 66-year-old woman with adalimumab therapy for rheumatoid arthritis followed by stuporous mental changes.


RESULTS
Magnetic resonance imaging scans showed multifocal parenchymal lesions and hemorrhage in the brainstem and supratentorial areas. Polymerase chain reaction analysis of the cerebrospinal fluid was positive for varicella-zoster virus. The patient died of multifocal vasculopathy despite intensive antiviral and antibacterial medication.


CONCLUSIONS
Varicella-zoster virus multifocal vasculopathy with encephalitis may be associated with adalimumab therapy. Clinicians should be aware of the possibility of fatal varicella-zoster virus vasculopathy with encephalitis in patients undergoing adalimumab therapy for rheumatoid arthritis.
Department of Neurology, College of Medicine, Hanyang University, 17 Haengdang-dong, Seongdong-gu, Seoul 133-792, Republic of Korea.
Wonki
W
Baek
Sang-Gon
SG
Lee
Young Seo
YS
Kim
Jae-Hoon
JH
Kim
Jae-Bum
JB
Jun
Hyun Young
HY
Kim
D000068879:Adalimumab; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects* / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D020804:Encephalitis, Varicella Zoster / Q000139:chemically induced* / Q000821:virology; D017809:Fatal Outcome; D005260:Female; D014645:Herpesvirus 3, Human; D006801:Humans; D020293:Vasculitis, Central Nervous System / Q000821:virology*
D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D000068879:Adalimumab