title: Intractable pneumococcal meningoencephalitis associated with a TNF-α antagonist.
abstract: A 34-year-old man was treated with a TNF-α antagonist for ankylosing spondylitis, and this subsequently developed a CNS infection. Magnetic resonance imaging showed diffuse subcortical white matter lesions. Streptococcus pneumoniae was cultured from the cerebrospinal fluid and blood. The patient died of multifocal widespread brain damage and subarachnoid hemorrhage, despite intensive antibacterial medication. Pneumococcal meningoencephalitis can occur in association with TNF-α antagonists. Clinicians should be aware of both the risk of fatal bacterial meningoencephalitis associated with TNF-α antagonists and the possibility of an unusual presentation of bacterial meningitis.
authors.affiliation: Departments of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea. Electronic address: go2dream@hanmail.net.
authors.forename: Seok-Jae
authors.initials: SJ
authors.lastname: Kang
authors.affiliation: Departments of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea. Electronic address: hyoungkim1@hanyang.ac.kr.
authors.forename: Hyun Young
authors.initials: HY
authors.lastname: Kim
authors.affiliation: Departments of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea. Electronic address: aescula@daum.net.
authors.forename: Young Seo
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Departments of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea. Electronic address: lhn077@hanmail.net.
authors.forename: Ha Neul
authors.initials: HN
authors.lastname: Lee
authors.affiliation: Departments of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea. Electronic address: kimht@hanyang.ac.kr.
authors.forename: Hee Tae
authors.initials: HT
authors.lastname: Kim
authors.affiliation: Departments of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea. Electronic address: kimjuhan@hanyang.ac.kr.
authors.forename: Seung H
authors.initials: SH
authors.lastname: Kim
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D038524:Diffusion Magnetic Resonance Imaging; D006801:Humans; D008297:Male; D008590:Meningoencephalitis / Q000097:blood / Q000134:cerebrospinal fluid / Q000209:etiology*; D011008:Pneumococcal Infections / Q000097:blood / Q000134:cerebrospinal fluid / Q000150:complications*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors / Q000378:metabolism*
chemical_list: D000893:Anti-Inflammatory Agents; D000998:Antiviral Agents; D014409:Tumor Necrosis Factor-alpha; D003907:Dexamethasone; D000212:Acyclovir
keywords: Bacterial meningitis; Infliximab; Meningoencephalitis; Streptococcus pneumoniae; TNF-α antagonist; White matter