title: Central nervous system manifestations of tuberculosis-associated immune reconstitution inflammatory syndrome during adalimumab therapy: a case report and review of the literature.
abstract: A 64-year-old neurologically asymptomatic woman with rheumatoid arthritis who was treated with the tumor necrosis factor (TNF)-α antagonist adalimumab developed disseminated tuberculosis (TB). After receiving anti-TB therapy and discontinuing adalimumab, she exhibited paradoxical worsening due to immune reconstitution inflammatory syndrome (IRIS) with the appearance of meningitis and brain tuberculomas. This case indicates that continuing anti-TNF therapy may be necessary to prevent IRIS in patients who develop TB, particularly disseminated TB, during the course of anti-TNF therapy. In addition, careful screening for central nervous system (CNS) TB should be performed prior to the initiation of therapy, as even neurologically asymptomatic patients can develop CNS manifestations of IRIS.
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization, Ibarakihigashi National Hospital; 2 Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Tanaka
authors.forename: Akimasa
authors.initials: A
authors.lastname: Sekine
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Tsunoda
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takoi
authors.forename: Shin-Yuan
authors.initials: SY
authors.lastname: Lin
authors.forename: Yohei
authors.initials: Y
authors.lastname: Yatagai
authors.forename: Kenji
authors.initials: K
authors.lastname: Hayasihara
authors.forename: Takefumi
authors.initials: T
authors.lastname: Saito
mesh_terms: D000068879:Adalimumab; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D005260:Female; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000517:prevention & control*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D016862:Tuberculoma, Intracranial / Q000517:prevention & control*; D014390:Tuberculosis, Meningeal / Q000517:prevention & control*; D014391:Tuberculosis, Miliary / Q000188:drug therapy
chemical_list: D000893:Anti-Inflammatory Agents; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D000995:Antitubercular Agents; D000068879:Adalimumab