Clinical Rheumatology

, Volume 29, Issue 10, pp 1201–1204 | Cite as

Cerebral tuberculoma in a patient receiving anti-TNF alpha (adalimumab) treatment

Case Report

Abstract

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.

Keywords

Adalimumab Anti-TNF Cerebral Rheumatoid arthritis. Tuberculoma 

Abbreviations

CDC

Centers for Disease Control

TNF

Tumor necrosis factor

ZN

Ziehl Nielson

GFAP

Glial fibrillary acidic protein

PPD

Purified protein derivative

RA

Rheumatoid arthritis

DMARDs

Disease-modifying anti-rheumatic drugs

LTBI

Latent tuberculous bacilli infection

IGRA

Interferon-gamma release assay.

Notes

Disclosures

The following case report is authored by Karen Lynch MD and Michael Farrell MD. It adheres to ethical guidelines and standards, and there was no financial or other conflict of interests associated with this case or the authors.

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Copyright information

© Clinical Rheumatology 2010

Authors and Affiliations

  1. 1.Department of NeuropathologyBeaumont HospitalDublin 9Ireland
  2. 2.Department of Neurology Tufts UniversitySt Elizabeth’s Medical CenterBostonUSA

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